Montana Council 9 Membership Card Form

First Name *

Last Name *

Email *

Work Email *

Middle Initial

Nickname (if any)

Address *

Address 1 *

Address 2

City *

State *

ZIP code *

Mailing Address (complete if different from street address)

Country

Address 1 *

Address 2

City *

State *

ZIP code *

Cell Phone † † By providing your cell phone number, you consent to receive calls (including recorded or autodialed calls, or texts) at that number from 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 AFSCME Council 9 AT [email protected].

Home Phone

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Date of Birth

Month

Day

Year

Select employer from dropdown *

Work Phone

Job Class / Title *

Work City *

Employee ID#

Date Hired Into Position

Month

Day

Year

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.

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

By checking this box, I agree that my typed name is the electronic representation of my signature and is legally binding -- just like pen and paper.