CWA Local 9333 Membership Form

Log In
For Members
Local 9333
D9 and National

Log In
For Members
Local 9333
D9 and National

Communications Workers of America Membership Form

I hereby request and accept membership in the Communications Workers of America (CWA) and when accepted by the Local, agree to be bound by the Constitution of the Union and Amendments thereto and Rules and Regulations now in effect or subsequently enacted by the Union and/or the Local to which I am assigned.

First Name *

Last Name *

Work Location Address *

City *

State *

ZIP *

Employee ID *

Job Title *

Home Address *

City *

State *

ZIP *

Personal Email Address *

Personal Phone Number *

Please Select One:Yes, I accept membership in the Communications Workers of America!No, I decline membership. I understand I don't get to vote for local union officers or on contracts.

Electronic SignatureThis typed electronic signature is equivalent to, and in place of, a hand-written signature. CWA and I agree that this card may be electronically signed and that the electronic signature appearing here is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility. *

Signature Date: *

Dues Deduction Form

I hereby authorize AT&T to deduct from the compensation (including disability benefits or vacation payments) due me an amount equal to the initiation fee certified in writing to the Company by the Secretary-Treasurer of the Communications Workers of America, or his/her duly constituted agent, and each month an amount equal to regular monthly Union dues, certified in writing to the Company by the Secretary-Treasurer of the Communications Workers of America, or his/her duly constituted agent. Each amount so deducted shall be remitted to the Secretary-Treasurer of the Communications Workers of America, or his/her duly constituted agent. If for any reason the Company fails to make a deduction, I authorize the Company to make such deduction in a subsequent payroll period.

This authorization is voluntarily made and is neither conditioned on my present or future membership in the Union, nor is it to be considered as a quid pro quo for membership. This authorization shall continue in effect until canceled by written notice signed by me and individually sent by registered or certified mail to the Company. This cancellation of authorization must be postmarked during the fourteen (14) day period prior to each anniversary date of the current or any subsequent Collective Bargaining Agreement, or during the fourteen (14) day period prior to the termination of the current or any subsequent Collective Bargaining Agreement.

First Name:

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Last Name:

{name-2}

Work Location Address:

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City:

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State:

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Zip

{address-4-zip}

Employee ID:

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Home Address:

{address-2-street_address}

City:

{address-6-city}

State:

{address-8-state}

Zip:

Personal Email Address:

{email-1}

Personal Phone:

{phone-1}

Dues Deduction Authorization *Yes, I choose to opt in for payroll dues deduction. I affirm that I am an employee employed by AT&T. I authorize AT&T to deduct from my salary an amount equal to regular monthly dues. This authorization shall remain in effect unless I cancel in writing.No, I choose to opt out of payroll dues deduction.

Electronic Signature *This typed electronic signature is equivalent to, and in place of, a hand-written signature. CWA and I agree that this card may be electronically signed and that the electronic signature appearing here is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.

Signature Date: *

Political Contributions Committee Payroll Deduction Form

First Name:

{name-1}

Last Name:

{name-2}

Occupation

Local Number: *

Home Address:

{address-2-street_address}

City:

{address-6-city}

State:

{address-8-state}

Zip

{address-7-zip}

Personal Email Address:

{email-1}

Personal Phone:

{phone-1}

Amount to Deduct Per Pay Period$5$15$20$25Other

Select One:New EnrollmentChange of AmountCancellation

Political Contributions Authorization *Yes, I hereby authorize my employer to deduct from my wages the listed sum each pay period and to remit such amount to the Communications Workers of America-Committee on Political Education Political Contributions Committee. (CWA-COPE PCC).No, I choose to opt out.

THIS AUTHORIZATION IS VOLUNTARILY MADE BASED ON MY SPECIFIC UNDERSTANDING THAT:

The signing of this authorization card and the making of contributions to CWA COPE PCC are not conditions of membership in the union nor of employment with the Company and that I may refuse to do so without fear of reprisal.

I am making a contribution to a joint fund-raising effort sponsored by CWA-COPE PCC and the AFL-CIO Committee on Political Education Political Contributions Committee (“AFL-CIO COPE PCC”) and that CWA-COPE PCC and AFL-CIO COPE PCC will use my contributions for political purposes, including but not limited to, the making of contributions to or expenditures on behalf of candidates for federal, state, and local offices and addressing political issues of public importance.

Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation, and the name of employer of individuals whose contributions exceed $200 in a calendar year.

Contributions or gifts to CWA-COPE PCC and AFL-CIO COPE PCC are not deductible as charitable contributions for federal income tax purposes.

Electronic Signature *This typed electronic signature is equivalent to, and in place of, a hand-written signature. CWA and I agree that this card may be electronically signed and that the electronic signature appearing here is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.

Signature Date: *

Please do not fill in this field.

CWA Local 9333

3144 N G Street
Suite 125, #310
Merced, CA 95340

info@cwalocal9333.com

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