Join United Campus Workers Utah

Join United Campus Workers Utah

Communications Workers of America Local 7765
Membership Information
Name*

First NameLast Name
Personal Email*
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Phone Number*
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Pronouns (optional)
Institutional Email
We will NOT use this to contact you, we use this for data quality purposes.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Employment Information
Employee type (select all that apply)*

Undergraduate StudentGraduate StudentInstructorLecturerResearcherPost-doctoral researcherFacultyStaffRetireeAdjunctFormer employeeTenuredTenure TrackNon-Tenure TrackResident Advisor/AssistantTeaching FacultyTeaching AssistantResearch AssistantOther
University*

University of UtahUtah State University
Department (old)
College
Department*
Building
Where your primary office/workplace/lab/etc. is located
Job Title*
Can we text you?*

YesNo
How did you hear about UCW Utah
e.g. who you spoke to, or where
What issues are you interested in? (select all that apply)

Student feesStipends/wages/salariesInternational student experienceSupportAdvisor/PI/Supervisor issuesMental healthCost of living / food insecurityCampus climate / safetyWork loadCoronavirusDiversityDiscriminationAccessibilityHealthcare/InsuranceChildcare/Support for ParentsInternational student issuesPublic funding for higher edOutreach/union membershipRespect/RecognitionLegislative and Political EngagementMutual aidLGBTQ+ justiceRacial JusticeAcademic FreedomParkingTransparencyInput on department and/or university policy/decision-makingOther
Can we contact you about volunteering as an organizer?

YesNo
How did you hear about UCW Utah? (old)

Union 101UCWU SocialUCWU RallyCoworkerA UCW MemberFlyerOther
Membership Dues and Donations
Select Your Income Bracket*

Under $20k/year: $10/month$20-35k/year: $12/month$35-50k/year: $20/month$50-65k/year: $25/month$65-80k/year: $30/monthAbove $80k/year: 1% of income
What is your annual salary from the university you work at?($)*
Monthly Membership Dues ($)
Dues are paid in monthly installments and begin the day you register.
Monthly Membership Dues
Optional Donations

(Not tax deductible)
Political Action Fund (optional): Contribute to CWA's political action fund to increase our influence in national, state, and district electoral struggles. See www.cwa-union.org/cwa-political-action-fund.

None$5/month$10/month$15/monthOther
UCWU Mutual Aid Fund (optional): Add a donation to our mutual aid fund which assists UCW members with financial insecurity.

None$1/month$5/month$10/monthOther
CWA 7765 General Fund (optional): Add an additional monthly donation to the union's general fund.

None$1/month$5/month$10/monthOther
$1 to cover transaction fees (optional): Add an optional $1 to your monthly contribution to help cover transaction fees. This frees up more of our funds for building our union.

None$1/month
Monthly dues plus optional donations ($)
Monthly Contributions
Membership Dues Authorization
I authorize the deduction from my bank account for membership dues to CWA 7765. I understand that I may revoke this authorization at any time by written notice to finance@cwa7765.org.*

Check to authorize
Signature*

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USDMonthly membership dues and donations

Your Banking Information
Bank Account Type
Routing Number	Account Number
Your Name On Account (no more than 22 characters)	Bank Name

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Join United Campus Workers Utah

Membership Information

Employment Information

Membership Dues and Donations

Optional Donations

Membership Dues Authorization