Montana Council 9 Membership Card

First Name

Last Name

Nickname

Personal Email

Work Email

Street Address

Apartment, Suite, etc.

City

State

ZIP/Postal Code

My mailing address is different from my street address

Mailing Address

Apartment, Suite, etc.

City

State

ZIP/Postal Code

Employer

Job Class/Title

Work City

Employee ID Number

Date of Hire

Work Phone

Home Phone

Cell Phone †

† By providing my cell phone number I consent to receive calls (including recorded or autodialed calls, or texts) at that number from AFSCME and its affiliated labor, political and charitable organizations on any subject matter. My carrier’s rates may apply. I may modify my preferences at https://www.afscme.org/tcpa.

Birthdate

Gender

I support advocating for quality services and good jobs. I understand that as an AFSCME 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.

Yes! I want to be a union member

Dues Authorization

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 AFSCME Montana Council 9 and Local constitution and by-laws and authorize my employer to remit such amount. Voluntary authorization and assignment shall be irrevocable for a period of one year from the date of execution and automatically renews year to year thereafter unless I give 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 an AFSCME bargaining unit. 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.

Signature

My electronic signature is a binding and valid signature. By signing here I agree to all of the terms and conditions set out in this authorization, which apply to my membership, dues payments and, if applicable, PEOPLE payments.