COUNT ME IN THE MAJORITY!

COUNT ME IN THE MAJORITY!
Name*

First NameLast Name
Preferred Name/Nickname
Personal Email*
example@gmail.com
Work Email*
example@waterboards.ca.gov
Home Address*

Street Address 1

Street Address 2

CityState

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Work Address*

Street Address 1

Street Address 2

CityState

Zip Code
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Work Phone
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Department*
Classification*
I accept membership in CAPS, UAW Local 1115 which represents me with respect to my working conditions at the State of California. I agree to pay a one-time $10 initiation fee and monthly dues in an amount certified by the Union and adjusted periodically by the Union consistent with the Union’s Constitution. I authorize the State Controller to deduct the initiation fee and monthly membership dues from my pay and remit them to the Union. Unless revoked, this authorization is to remain in effect consistent with the law.
Signature*

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Get Involved With Your Union

I want to help make my Union stronger! Contact me about getting involved.
Date (MM-DD-YYYY)*

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