Local 217 Dues, Membership & TIP Card

Local 217 Dues, Membership & TIP Card
REPRESENTATION AUTHORIZATION
I hereby authorize UNITE HERE Local 217 ("the Union") to be my recognized or certified collective bargaining representative in all matters relating to my wages, hours and terms and conditions of employment at my current employer(s) and any future employers, and request and accept membership in the Union. I hereby agree to be bound by the Constitution of the UNITE HERE International Union and the bylaws of the Union.
DUES CHECKOFF
I hereby voluntarily request and authorize my employer to deduct from any wages or compensation due me, each and every month, the dues, back dues, initiation fees or reinstatement fees required as a condition of acquiring and maintaining membership in good standing in the Union, and I direct that the same be forwarded each month to the Union. This authorization shall remain in effect and shall be irrevocable unless I revoke it by sending written notice to both the Employer and the Union by registered mail during a period of ten (10) days immediately after any anniversary of the date of this authorization or after the date of termination of the applicable agreement between my Employer and the Union, whichever occurs sooner, and shall be automatically renewed as an irrevocable check off from year to year, unless revoked as hereinabove provided irrespective of whether I am or remain a member of the Union.

I acknowledge that I have received and read the Notice Regarding Union Security Clause and Dues/ Fees Deduction Authorization, which is printed below. I understand that I may request a copy of the notice before I sign this card and the notice will be given to me.

If you wish to pay your dues and fees directly to the Union and not have a payroll deduction, initial below. You will then be required to pay your dues and fees directly to the Union each month, on time.
Initial here if you would like to pay your dues and fees directly to the Union and not have a payroll deduction.
Name

First NameLast Name
Social Security Number
Date

MonthDayYear
Date
Email
example@example.com
Cell Phone Number
Please enter a valid phone number.
* By including your email and cell phone you are opting into text and email outreach from UNITE HERE. Standard rates may apply for texts.
Home Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Signature

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Current Employer
Date of Hire
Job
Work location
Hourly Wage
Hours Worked / Week

NOTICE REGARDING UNION SECURITY CLAUSE AND DUES DEDUCTION AUTHORIZATION
As an employee working under UNITE HERE Local 217 contract containing a union security clause, you are required, as a condition of employment, to pay dues and/or fees to the Union. This is the only obligation under the union security clause. You do not have to actually become a member of the Union. Individuals who are members pay dues, while individuals who are nonmembers pay an equivalent fee. This fee, which is authorized by law, is your fair share of sustaining your union's broad range of programs in support of you and your co-workers, but nonmembers may file objections to funding expenditures that are nongermane to the Union's duties as collective bargaining agent and thereby be obligated to fees representing expenditures germane to the Union's duties as collective bargaining agent. Nonmembers have the right to be given sufficient information to enable them to intelligently decide whether to object, and to be apprised of the Union's internal procedures for filing objections. Individuals may obtain a description of the procedures which must be followed to file such objections, and further information, by writing to Local 217–UNITE HERE, 425 College Street, New Haven, CT, 06511.

Nonmember fee payers give up many benefits that only Union members receive. As a member you will have all the benefits and privileges of membership, including the right to fully participate in the internal activities of the union, the right to attend and participate in membership meetings, the right to participate in the development of contract proposals and to participate in contract ratification and strike votes, the right to vote to set or raise dues and fees, the right to nominate and elect Union Officers, the right to run for Union office and for convention delegate.

The Union Privilege Program of the AFL-CIO, available to members, offers only Union members such services as: reduced rate Mastercard, reduced fee legal services, a prescription program with savings for long-term users of prescribed medicine, a mortgage program that allows Union members to receive reduced interest rates, a dental program, a lending program and many other services available to Union members at lower rates.

The authorization for dues and/or fees deduction is voluntary. If you do not wish the convenience of this payroll deduction but prefer to pay your dues and/or fees directly to the Local Union office each month, you may do so. If you do not sign the dues deduction authorization you must then pay your dues and/or fees to the Local Union 217 offices by the 10th of each month.

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UNITEHERE! TIP CAMPAIGN COMMITTEE CHECK-OFF AUTHORIZATION FOR POLITICAL CONTRIBUTIONS FROM WAGES
I hereby authorize and direct the Payroll Department to deduct from my salary the sum indicated below each 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 membership 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.
I hereby authorize and direct the Payroll Department of
Employer Name
to deduct from my salary the sum indicated below each week.
Weekly Deduction Amount
Name

First NameLast Name
Signature

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Date

MonthDayYear
Date
Social Security Number
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 administrativestaff,or their family members, may contribute. Contributions or gifts to the UNITE HERE TIP Campaign Committee are not tax deductible.
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Local 217 Dues, Membership & TIP Card

REPRESENTATION AUTHORIZATION

DUES CHECKOFF

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