Local 90 Application and Notice for Checkoff Authorization

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I voluntarily submit this Application for Membership in Local Union #90, 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 only available 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 workers. I have read and understand the options available to me and submit this application to be admitted as a member of the Local Union.

Name

First NameMiddle NameLast Name

Address

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Date of Birth

MM-DD-YYYY

Social Security Number

Terms and Conditions

Signature

By checking the box, I hereby authorize my employer to deduct from my wages each and every month an amount equal to the monthly dues, initiation fees, and uniform assessments of Local Union # 90, and direct such amounts so deducted to be turned over each month to the Secretary-Treasurer of such Local Union for and on my behalf.

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 the employer 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 the Union at least sixty (60) days, but not more than seventy-five (75) days before any periodic renewal date of this authorization and assignment of my desire to revoke same.

Union dues are not deductible as charitable contributions for Federal Income Tax purposes.

Employer

Employer Street Address

Employer City

Employer State

Employer Zip Code

Dues Checkoff Authorization

Signature

TEAMSTERS LOCAL 90

Membership Application

Dues Checkoff Authorization