WVTA L2019 RETIRED w/out PAC Membership Dues - CC

WEST VIRGINIA TROOPERS ASSOCIATION

Retired member w/out PAC
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.
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
West Virginia County*
Title*
Troop number
If you are retired trooper, please let us know your retirement date*

MonthDayYear
Date
Permanent ID Number/Employee ID Number
Work Location (address)*

Street Address

Street Address Line 2

CityState

Zip Code
Beneficiary for Life Insurance

Accidental Death
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.
Recurring Monthly 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.

RETIRED MEMBERS without PAC

As a retired member who does not contribute to PAC, I authorize the West Virginia Troopers Association to charge me union dues totaling $5.31 monthly.

If you want your membership dues to be deducted on a payday, make sure that you sign up 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*

RETIRED MEMBER w/out PAC - Monthly membership dues

$5.31 for each month

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

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WEST VIRGINIA TROOPERS ASSOCIATION

Personal Information

Employment Information

Beneficiary for Life Insurance

Recurring Monthly Deduction