Retiree Membership Application

Retain your union benefits after retirement by applying for Retiree Membership.*

Name

Last Name

Suffix

Mailing Address

City

State

Zipcode

Phone

Phone Type

Home Cell

Monthly Dues Rate

Retired Associate Member: $4.40 dues Retired Spouse Associate Member: $2.60 dues

Effective Date of Retirement

I hereby apply for in the United Public Workers, Local 646, AFL-CIO (hereafter “UPW”) and I agree to abide by its Constitution and Bylaws. I understand I must meet UPW’s membership eligibility requirements before membership is approved; that approved membership will continue irrespective of changes in employment and until I submit a written resignation of membership, or my membership is terminated by UPW in accordance with the UPW Retiree Chapter Bylaws; that I am responsible for notifying UPW of any change to the information provided on this form.

*To be eligible for benefit programs sponsored by the UPW, the Retired Associate Member is required to have no break in membership from an active member to a retired associate member.

Protecting Retirement

Hawaii's UPW AFSCME Retiree Chapter 646 serves retired members and their families. Apply for Retiree Membership to retain your union benefits after retirement.

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Retiree Membership Application

Protecting Retirement

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