WVTA L2019 ACTIVE Membership Dues - CC

WEST VIRGINIA TROOPERS ASSOCIATION

Application for membership
Dues are used for bargaining contracts, defending our worker's rights, solving issues in the workplace, and organizing campaigns. The West Virginia Troopers Association's members in disputes and negotiating contracts, legal fees to defend our contracts, union meetings, training programs, and maintaining the local office.

The West Virginia Troopers Association (WVTA) is part of a larger umbrella union, the Communications Workers of America (CWA) represents 700,000 workers in private and public sector employment in 1,200 chartered CWA local unions.

As an active member, $2.00 per month from your dues will be allocated to the WVTA Political Action Committee (PAC ). The WVTA PAC committee was created to raise and distribute funds in support of, or in opposition to, political candidates who impact the interests of our members.
Personal Information
Full Name*

First NameMiddle NameLast NameSuffix
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Date of Birth*

MonthDayYear
Personal Email Address*
example@example.com
Personal Cell Phone*
Please enter a valid phone number.
Employment Information
Employer*

State of West Virginia
Hire Date*

MonthDayYear
Date
West Virginia County*
Title*
Troop number
If you are retired trooper, please let us know your retirement date*

MonthDayYear
Date
Work Location (address)*

Street Address

Street Address Line 2

CityState

Zip Code
Beneficiary for Life Insurance

Boston Mutual Life Insurance-Please call the WVTA office w/personal information needed once you are a member. (304)345-9882
Name of the Beneficiary*

First NameLast Name
Relationship*
Beneficiary Date of Birth*

MonthDayYear
Beneficiary Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Beneficiary Cell Phone*
Please enter a valid phone number.
Permanent ID Number/Employee ID Number*
Recurring Bi-weekly Union Dues Deduction
With the West Virginia Troopers Association, dues are used for bargaining contracts, defending our worker rights, solving issues in the workplace, and organizing campaigns. We represent members in disputes and negotiate contracts, legal fees to defend our contracts, union meetings, training programs, and maintaining the local office.

Once I am accepted as a new member or I enter my dues payment method as an existing member, I authorize the West Virginia Troopers Association to charge me union dues totaling $10.46 bi-weekly.

If you want your membership dues to be deducted on a payday, make sure that you signup on a payday.

For example, if you sign up on February 11th, your first dues will be deducted on that same day and your next dues payment will be automatically deducted on February 25th and so on.

Membership dues payment method*

ACTIVE MEMBER - Bi-weekly membership dues

$10.46 for each two weeks

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Employee E-Signature*

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WEST VIRGINIA TROOPERS ASSOCIATION

Personal Information

Employment Information

Beneficiary for Life Insurance

Recurring Bi-weekly Union Dues Deduction