OMCA Workers United Membership Card

First Name

Middle Initial

Last Name

Address

Address 2

City

State

Postal Code

Employer

Job Title

Department

Personal Email

Cell Phone †

† By providing your cell phone number you 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. Your carrier’s rates may apply. You may modify your preferences at: https://www.afscme.org/tcpa.

Authorization

I, the undersigned, hereby designate the American Federation of State, County and Municipal Employees Council 57, AFL-CIO as my duly chosen and authorized exclusive representative on matters relating to my employment in order to promote and protect my economic welfare.

Upon ratification of our first contract, I hereby assign to the American Federation of State, County and Municipal Employees Council 57 and authorize you to deduct from any salary earned by me an amount equal to dues and assessments, as certified by AFSCME Council 57. I further authorize and request you to remit the amount deducted to AFSCME Council 57 each month.

This authorization shall remain in effect for one year irrespective of whether I am a union member, and be automatically renewed for periods of one year from the date signed below, or until the expiration of the collective bargaining agreement, whichever is sooner. I can revoke this authorization by sending written notice to my employer and to the union no more than 30 days and not less than 10 days before the expiration of the yearly period or before the expiration of the collective bargaining agreement, whichever is sooner. Contributions to AFSCME are not deductible as charitable contributions for income tax purposes.

Signature

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Saturday, September 13, 2025 - 04:11