Yes, I want to save our union voice and be an AFSCME member!

Full Time Member Application

Membership
Council:   Local:
Department:
Name:
Address:  
, -
Home Phone: Textable?     Cell Phone: Textable?
Home Email:   Occupation/Job Title:
Dues Deduction Amount
Yes, I want to be an AFSCME member to proudly continue the Fight to Take Back Our Rights!
I authorize a monthly dues deduction in the amount of (please choose one): $35.00   $40.00
+ AFSCME PEOPLE Contribution (Optional)
Yes, I also want to join AFSCME PEOPLE* and support campaign contributions to those candidates who will protect our rights.
Please regularly deduct my voluntary contribution to AFSCME PEOPLE* in the amount of
$8.34 (MVP level) Other: $ $0.00 (I do not wish to join AFSCME PEOPLE*)
*American Federation of State, County & Municipal Employees PEOPLE (AFSCME PEOPLE) is the Federal political committee sponsored by AFSCME and is funded by voluntary contributions, not union dues. AFSCME PEOPLE uses these contributions for political purposes, including, but not limited to, making contributions to and expenditures on behalf of candidates who support working families. Only U.S. citizens or lawful permanent residents may contribute to AFSCME PEOPLE. Contributions to AFSCME PEOPLE are entirely voluntary, and are not required as a condition of continued employment or of membership in AFSCME or any of its affiliates. Any suggested contribution amount is only a suggestion, and you are free to contribute more or less than that amount (or to contribute nothing) without fear of reprisal. No person will be favored or disadvantaged by reason of the amount or their contribution or their decision not to contribute. AFSCME PEOPLE does not accept contributions from persons other than AFSCME members, officers, administrative employees, and their families. All donations from other persons will be returned. Contributions to AFSCME PEOPLE are not deductible as charitable contributions for federal income tax purposes. Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation, and name of employer for each individual whose contributions to AFSCME PEOPLE aggregate in excess of $200 in a calendar year.
Payment Authorization
Electronic Bank Draft
Debit/Credit Card

I prefer monthly debits from my: Checking Account   Savings Account

Bank Name:
Bank City, State: ,
Bank Routing #: get info   Account #:

I prefer monthly charges to my debit or credit card.

Debit/Credit Card:   Card #:
Security Code: get info   Expiration Date: /
Check this box to confirm that you are eligible to make debit/credit card contributions to PEOPLE
1) This contribution is made from my own funds, and not those of another. 2) This contribution is not made from the general treasury funds of a corporation, labor organization or national bank. 3) I am not a foreign national who lacks permanent resident status in the United States. 4) This contribution is not made from the treasury of an entity or person who is a federal contractor (does not apply to personal contributions by subcontractors, employees, partners, shareholders or officers of federal contractors). 5) This contribution is made on a personal credit or debit card for which I have legal obligation to pay, and is made neither on a corporate or business entity card nor on the card of another.
I hereby authorize AFSCME Council 40, hereinafter called AFSCME, to initiate monthly debit or charge entries in the amount(s) specified above to the bank or debit card/credit card account specified. This authorization is to remain in full force and effect until I revoke or change this authorization, which I may do at any time by notifying AFSCME in writing of such revocation or change in such time and manner that AFSCME is afforded a reasonable opportunity to act on it and at least three (3) business days before the next scheduled debit. Debit or charge entries will be initiated between the 13th and 17th day of each month. A record of each transaction will appear on my account statement and will serve as my receipt. I understand that if a debit entry is returned by my Bank as NSF or Uncollected Funds, that the debit entry will be automatically resubmitted to my bank account and I may be charged a return fee up to $25.00.

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