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_______________________ First Name, Middle Initial, Last Name
_________________________________ Social Security Number UNITED STEELWORKERS USW AFl-CIO-ClC Local Union No. 13-447I hereby request and accept membership in the United Steel, Paper and Forestry, Rubber, Manufacturing, Energy, Allied Industrial and Service Workers International Union (also known in short as ("United Steelworkers" or "USW"). and of my own free will hereby authorize the USW. its agents or representatives, to act for me as a collective bargaining agency in all matters pertaining to rates of pay, wages. hours of employment, or other conditions of employment, and to enter into contracts with my employer covering all such matters including contracts which may require continuance of my membership with United Steelworkers, as a condition of my continued employment. Date: _________________________ Signature: ___________________________________________________________________ Name: _________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ Street Address/Postal Office Box No. _________________________________________________________________________________________________________________ City State Zip Code Telephone Number: ( ) ____________ - _____________________ E-Mail: ____________________________________________ Social Security No. _________________________________ Employer: _____________________________________ Facility: ________________________________________________ Department: ___________________________________ Initiation fee: _____________________________ paid UNITED STEELWORKERS (USW) CHECK-OFF AUTHORIZATION
_________________________________________ EMPLOYER _________________________________________ ________________________________20________ FACILITY DATE Pursuant to this authorization and assignment, please deduct from my pay each month, while I am in the employment with the collective bargaining unit in the Employer, and irrespective of my membership status in the Union, monthly dues, assessments and [if owing by me) an initiation fee each as designated by the International Secretary/Treasurer of the Union.The aforesaid payment shall be remitted promptly by you to James D. English, or his successor, International Secretary/ Treasurer of the International Union, AFL-CIO, CLC, (also known in short as the "Union", "United Steelworkers or "USW") or its successor, Five Gateway Center, Pittsburgh Pa.15222This assignment and authorization shall be effective and cannot be cancelled for a period of one (1) year from the date appearing above or until the termination of the date of the current collective bargaining agreement between the Employer and the Union, whichever occurs sooner. I hereby voluntarily authorize you to continue the above authorization and assignment in effect after the expiration of the shorter of the periods above specified, for further successive periods of one (1) year from such date. I agree that this authorization and assignment shall become effective and cannot be cancelled by me during any such years, but that I may cancel and revoke be given to the appropriate management representative of the facility in which I am then employed, an individual written notice signed by me and which shall be postmarked or received by the employer within fifteen (15) days following the expiration of any such year or within the fifteen (15) days following the termination date of any collective bargaining agreement between the Employer and the Union covering my employment if such date shall occur within one of such annual periods. Such notice of revocation shall become effective respecting the dues for the month following the month in which such written notice is given; a copy of which is given to me by the Financial Secretary of the Local Union.While contributions or gifts to the USW are not tax deductible as charitable contributions for Federal income tax purposes, they may be tax deductible under other provisions of the Internal Revenue Code. (USW) Local Union No. 13-447 Signature___________________________________________Witness _______________________________________ Check No. _________________________ ………………………………………………………………………………
……………………………………………………………………… UNITED STEELWORKERS (USW) CHECK-OFF AUTHORIZATION _________________________________________ EMPLOYER _________________________________________ ________________________________20________ FACILITY DATE Pursuant to this authorization and assignment, please deduct from my pay each month, while I am in the employment with the collective bargaining unit in the Employer, and irrespective of my membership status in the Union, monthly dues, assessments and [if owing by me) an initiation fee each as designated by the International Secretary/Treasurer of the Union.The aforesaid payment shall be remitted promptly by you to James D. English, or his successor, International Secretary/ Treasurer of the International Union, AFL-CIO, CLC, (also known in short as the "Union", "United Steelworkers or "USW") or its successor, Five Gateway Center, Pittsburgh Pa.15222This assignment and authorization shall be effective and cannot be cancelled for a period of one (1) year from the date appearing above or until the termination of the date of the current collective bargaining agreement between the Employer and the Union, whichever occurs sooner. I hereby voluntarily authorize you to continue the above authorization and assignment in effect after the expiration of the shorter of the periods above specified, for further successive periods of one (1) year from such date. I agree that this authorization and assignment shall become effective and cannot be cancelled by me during any such years, but that I may cancel and revoke be given to the appropriate management representative of the facility in which I am then employed, an individual written notice signed by me and which shall be postmarked or received by the employer within fifteen (15) days following the expiration of any such year or within the fifteen (15) days following the termination date of any collective bargaining agreement between the Employer and the Union covering my employment if such date shall occur within one of such annual periods. Such notice of revocation shall become effective respecting the dues for the month following the month in which such written notice is given; a copy of which is given to me by the Financial Secretary of the Local Union.While contributions or gifts to the USW are not tax deductible as charitable contributions for Federal income tax purposes, they may be tax deductible under other provisions of the Internal Revenue Code. (USW) Local Union No. 13-447 Signature___________________________________________Witness _______________________________________ Check No. _________________________
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