Union dues and other payments made to the Union are not tax-deductible...

I voluntarily submit this Application for Membership, affiliated with the International Brotherhood of Teamsters, so that I may fully participate in the activities of the Union. I understand that by becoming and remaining a member of the Union, I will be entitled to attend membership meetings, participate in the development of contract proposals for collective bargaining, vote to ratify or reject collective bargaining agreements, run for Union office, or support candidates of my choice, receive Union publications, and take advantage of programs available only to Union members. I understand that only as a member of the Union will I be able to determine the course the Union takes to represent me in negotiations to improve my wages, fringe benefits and working conditions. And, I understand that the Union’s strength and ability to represent my interests depends upon my exercising my right, as guaranteed by federal law, to join the Union and engage in collective activities with my fellow worker.

I understand that under the current law, I may elect “nonmember” status and can satisfy any contractual obligation necessary to retain my employment by paying an amount equal to the uniform dues and initiation fee required of members of the Union. I also understand that if I elect not to become a member or remain a member, I may object to paying the pro-rate portion of regular Union dues or fees that are not germane to collective bargaining, contract administration and grievance adjustments, and I can request the Local Union to provide me with information concerning its most recent allocation of expenditures devoted to activities that are both germane and non-germane to its performance as the collective bargaining representative sufficient to enable me to decide whether or not to become an objector. The current pro-rata percentage of regular Union dues and fee is 86.62%. I understand that nonmembers who choose to object to paying the pro-rata portion of regular Union dues or fees that are not germane to collective bargaining will be entitled to a reduction in fee based on the aforementioned allocation of expenditures, and will have the right to challenge the correctness of the allocation. The procedures for filing such challenges will be provided by my Local Union, upon request.

Checkoff Authorization and Assignment (where applicable) “I hereby authorize my Employer to deduct from my wages my monthly union dues, initiation fees, transfer fees, reinitiation fees, fines, back dues and assessments owing to Teamsters Local Union No. 120, affiliated with the International Brotherhood of Teamsters, 9422 Ulysses St. NE, #120, Blaine, MN 55434, of which I am a member or about to become a member and direct that such amounts so deducted be sent to the Secretary-Treasurer of said Local Union, for and on my behalf. These deductions are to be made in the following manners:

Initiation fees, reinitiation fees and transfer fees shall be deducted in 4 monthly payments, plus the monthly dues, back dues, fines and assessments calculated as defined below. Dues shall be the greater of the minimum monthly dues established by the International Brotherhood of Teamsters or Teamsters Local Union No. 120 rounded to the nearest whole dollar. This authorization is voluntary and is not conditioned on my present or future membership in the Union.

This authorization and assignment shall be irrevocable for the term of the applicable contract between the Union and Company, or for one year, whichever is the lesser, and shall automatically renew itself for successive yearly or applicable contract periods thereafter, whichever is lesser, unless I give written notice to the Company and Union at least sixty (60) days and not more than seventy-five (75) days before the periodic renewal date of this authorization, or upon notice given at the expiration of the applicable contract, of my desire to revoke the same.

I subscribe, freely and voluntarily the sum indicated on the previous page each week to DRIVE with the understanding that this voluntary contribution may be used by DRIVE for political purpose, including contributions to support candidate for local, state and federal offices. I understand my right to refuse to contribute without reprisal and that the amounts listed serve merely as suggestions. I am free to subscribe more, less, or nothing, without benefit or disadvantage.

I further hereby authorize and request my employer to deduct from my earnings the sum indicated on previous page each week to be remitted to National DRIVE.

I reserve the right in accordance with the applicable state or federal laws to revoke this voluntary authorization at any time by giving written notice of such revocation to National DRIVE in accordance with such laws or otherwise.

A copy of the DRIVE report is filed with the Federal Election Commission and is available for purchase from the Federal Election Commission, Washington, D.C. 20463. Donation not U.S. tax deductible.