I hereby apply for membership in the United Public Workers, Local 646 (hereafter “UPW”) and I agree to abide by its Constitution and Bylaws. I authorize UPW and its successor or assign to act as my exclusive bargaining representative for purposes of collective bargaining with respect to wages, hours and other terms and conditions of employment with my Employer.

Effective immediately, I hereby voluntarily authorize and direct my Employer to deduct from my pay each pay period, regardless of whether I am or remain a member of UPW, the amount of dues certified by UPW, and as they may be adjusted periodically by UPW, and to authorize my Employer to remit such amount monthly to UPW.

This voluntary authorization and assignment shall remain in effect, regardless of whether I am or remain a member of UPW, for a period of one year from the date of execution, and for year to year thereafter unless I provide UPW written notice of revocation within thirty (30) days before the anniversary of the execution date of this card. This card supersedes any prior check-off authorization card I signed.

I recognize that my authorization of dues deductions, and the continuation of such authorization from one year to the next, is voluntary and not a condition of my employment.

Payments to UPW are not deductible as charitable donations for federal income tax purposes. However, state law may extend favored tax treatment.