MEMBERSHIP CARD FORM

WFSE Member Card

When we work together, we are unstoppable. History has shown that when we stand together as a union, we can build a better future for our communities, our families, and our jobs. Union membership matters. ______________________________________________________ • Fair Pay • Affordable Health Care • Retirement Security • Preserving Public Services ______________________________________________________ This is an official Payroll Deduction Authorization form for union dues. Payments to the union are not deductible as charitable donations for federal income tax purposes. Learn more about union membership at www.wfse.org

MEMBERSHIP CARD FORM

Member Information

First Name*

Middle Initial

Last Name*

Nickname

Date of Birth

Gender

Other language used at home

Contact Information

Address

Zip Code

City

State

Mailing Address

Mailing Zip Code

Mailing City

Mailing State

BY PROVIDING YOUR CELL PHONE NUMBER, YOU CONSENT TO RECEIVE CALLS (INCLUDING RECORDER OR AUTODIALED CALLS, OR TEXTS) AT THAT NUMBER FORM THE UNION AND ITS AFFILIATES ON A PERIODIC BASIS. THE UNION WILL NEVER CHARGE FOR TEXT MESSAGE ALERTS. YOUR CARRIER'S RATES MAY APPLY. YOU MAY MODIFY YOUR PREFERENCE BY EMAILING THE WFSE MEMBER CONNECTION CENTER (MCC) AT [email protected] OR BY CALLING THE MCC AT 833-MCC-WFSE (833-622-7373)

Cell Phone

Home Email*

Home Phone

Work Phone

Work Email*

Job Information

Employer*

Job Class/Title

Work City*

Work County

Employee ID #

Date Hired into Position

Select your Work Shift

YES! I want to be a union member. I support advocating for quality services and good jobs. I understand that as a WFSE member I will help make our union stronger to protect public services and work together to improve pay, benefits and working conditions for all public employees. Effective immediately, I hereby voluntarily authorize and direct my Employer to deduct from my pay each pay period, an amount equivalent to dues as set in accordance with the Washington Federation of State Employees (WFSE) Constitution and By-Laws and authorize my Employer to remit such amount semi-monthly to the Union (currently 1.5% of my salary per pay period not to exceed the maximum, capped at $125.66 per month as of July 1, 2024). This voluntary authorization and assignment shall be irrevocable for a period of one year from the date of execution or until the termination date of the collective bargaining agreement (if there is one) between the Employer and the Union, whichever occurs sooner, and for year to year thereafter unless I give the Employer and the Union written notice of revocation prior to the end of any yearly period, regardless of whether I am or remain a member of the Union, unless I am no longer in active pay status in a WFSE bargaining unit; provided however, if the applicable collective-bargaining agreement specifies a longer or different revocation period, then only that period shall apply. This card supersedes any prior check-off authorization card I signed. I recognize that my authorization of dues deductions, and the continuation of such authorization from one year to the next, is voluntary and not a condition of my employment.