IRONWORKERS LOCAL 92 CHECK-OFF AUTHORIZATION

I hereby authorize and direct all employers for whom I am or may be employed under the terms of a collective bargaining agreement with Iron Workers Local 92 to deduct and forward to the Union or its designee a sum equal to four- and one-half percent (4.5%) of my gross weekly wages for working assessments. In addition to the percentage deducted for working assessments, I authorize employers covered by a collective bargaining agreement with Local 92 to deduct and transmit to the Union any dues, initiation fees, readmission fees and any other fee or assessment I may owe the Union in accordance with its Constitution and Bylaws. This check-off authorization extends to all present and future jobs and employers within the jurisdiction of Local 92. These deductions do not include contributions made by employers to the Health and Welfare Fund, Pension Fund, or Apprenticeship Fund. If at any time, the Union notifies my employer that there has been a change in dues, fees, or assessments, I authorize a corresponding change in the deduction amount. Ireserve the right to revoke this authorization by giving written notice by certified mail or hand delivery to my employer (if employed at the time) and Local 92 during the ten (10) days immediately preceding the annual anniversary date of this authorization or during the ten (10) days immediately preceding the expiration of the applicable collective bargaining agreement between my employer at the time and the Union. Unless revoked in writing as described above, this authorization shall automatically renew as an irrevocable check-off from year-to-year. This authorization shall remain in effect irrespective of my membership in the Union. I understand that the employer's responsibility is strictly limited to the check-off and delivery of amounts withheld to the Union. This check-off authorization was voluntarily executed by me on the date indicated below.

This check-off is required to keep you in "Good-Standing" with the Local.

I hereby authorize and direct my employer and all other employers for whom I may be employed under the terms of a Collective Bargaining Agreement with Local 92 to deduct from my wages and forward to Local 92 or its designee the amounts specified in the then current collective bargaining agreement for PAL (Political Action League) fund. This is a voluntary payment and not a condition of employment or membership in the Union. I understand that the Union cannot favor or disadvantage me because of my decision to contribute or not to contribute to the fund. I have the right to refuse to sign this authorization and to refuse to contribute to the fund without reprisal. Local 92 may use the money contributed for political purposes, including political expenditures and contributions in connection with state, local or federal elections. I understand that I may revoke this agreement at any time without reprisal by providing written notice to the Union. Unless revoked in writing, the agreement shall automatically renew on the one-year anniversary of its signing. I recognize that my employers' responsibility is strictly limited to the check-off and delivery of such funds to the Union. The current amount is $.07/hour.

I hereby authorize and direct my employer and all other employers for whom I may be employed under the terms of a Collective Bargaining Agreement with Local 92 to deduct from my wages and forward to Local 92 or its designee the amounts specified in the then current collective bargaining agreement or wage sheet for vacation. This is a voluntary payment and not a condition of employment or membership in the union. I recognize that the union cannot favor or disadvantage me because of the decision to contribute or not to contribute to the fund. I have the right to refuse to sign this authorization and to not contribute to the fund without reprisal. Local 92 will use the money contributed in accordance with the vacation procedures adopted by the Union. I understand that I may revoke this agreement at any time without reprisal by providing written notice to the Union. Unless revoked in writing, the agreement shall automatically renew on the one-year anniversary of its signing. I recognize that my employers' responsibility is strictly limited to the check-off and delivery of such funds to the Union. The current amount is $2.00/hour.