PWUA Membership Application

PWUA Membership Application
Name*

First NameLast Name
Employer*
Workplace*
Employment Type
Position
Employee ID
Email*
example@example.com
Mobile Phone Number*
Please enter a valid phone number.
Home Phone Number
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
CONDITIONS

I authorise the PWUA to represent me in employment related matters.

I authorise my employer to deduct fees from my wages/salary and send them to the PWUA.

Current fees deductions are $6.95 when working 30 or more hours a week, and $3.45 when working less than 30 hours a week.
Signature*

Powered by Jotform SignClear
Should be Empty: