Local 634 Union Member Registration

MEMBERSHIP ENROLLMENT FORM

SCHOOL CAFETERIA EMPLOYEES LOCAL 634, UNITE HERE
I hereby make application for membership. I understand that dues paid to the School Cafeteria Employees Local 634 UNITE HERE may not be deductible for federal income tax purposes; however, under limited circumstances, dues may qualify as a business expense. Dues are deductible on Pennsylvania income tax.
AUTHORIZATION FORM FOR VOLUNTARY PAYROLL DEDUCTION

I hereby authorize the School District of Philadelphia to deduct from my earnings each pay period the amount necessary to pay professional dues to the School Cafeteria Employees Local 634 UNITE HERE, as set forth in the official notification filed by Local634 with the Board of Education. This authorization shall be irrevocable during the duration of the collective bargaining agreement in effect between the School District and Local 634, and shall be automatically renewable for the term of any successive collective bargaining agreement, unless revoked by me by notifying the School District of Philadelphia and Local 634 in writing during the period of fifteen days prior to the expiration of any such agreement, or at such times as I cease to be employed in a position included in the bargaining unit represented by the Local 634.
Name *

First Name Last Name
Work Location
Position
School Code Number
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Email*
Enter your email address to receive a copy of your card.
Cell Phone*
Home Phone
* By including your email and cell phone you are opting into text and email outreach from UNITE HERE Local 634. Standard rates may apply for texts.
Sex
Employee ID *
Signature *

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Today's Date *

Month Day Year
Date

UNITEHERE! TIP CAMPAIGN COMMITTEE
CHECK-OFF AUTHORIZATION FOR POLITICAL CONTRIBUTIONS FROM WAGES

I hereby authorize and direct the Payroll Department of the School District of Philadelphia to deduct from my salary the sum indicated below per week and to transmit that sum to the UNITE HERE TIP Campaign Committee. I understand that (1) my contributions will be used for political purposes to advance the interests of the members of UNITE HERE, their families, and all workers, including support of federal and state candidates and political committees and addressing political issues of public importance; (2) contributing to the UNITE HERE TIP Campaign Committee is not a condition of member- ship in UNITE HERE or any of its affiliates, or a condition of employment; (3) I may refuse to contribute without reprisal; and (4) any guideline contribution amounts proposed by UNITE HERE are only suggestions; I may contribute more or less than those amounts, and I will not be favored or disadvantaged by UNITE HERE because of the amount of my contributions or my decision not to contribute.
Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation and name of employer of individuals whose contributions exceed $200 in a calendar year. Only U.S. citizens and lawful permanent residents who are UNITE HERE members or UNITE HERE executive or administrative staff, or their family members, may contribute. Contributions or gifts to the UNITE HERE TIP Campaign Committee are
not tax deductible.
Weekly Deduction (USD$)
Signature *

Clear
Today's Date *

Month Day Year
Date
Email2
example@example.com
Should be Empty:

MEMBERSHIP ENROLLMENT FORM

UNITEHERE! TIP CAMPAIGN COMMITTEE