UAW Local 4121 Membership and Dues Deduction Our strong majority membership helps us win improvements at UW and beyond. Question Title * Declare your membership by checking each box to indicate YES to the following: I accept membership in UAW Local 4121. By signing up for membership I’m helping to make our union stronger and more democratic so we can continue to win improvements. I hereby authorize the University of Washington to deduct from my pay and remit to the union my one-time $10 initiation fee and monthly membership dues in accordance with the UAW Constitution (currently 1.44% of my gross monthly pay). Unless revoked, this authorization is to remain in effect any time I am a UAW member and working in a position represented by UAW 4121. I recognize that my authorization of dues deductions and the continuation of such authorization is voluntary and not a condition of my employment. By checking this box, I agree that my typed name below is the electronic representation of my signature and is legally binding – just the same as a pen-and-paper signature. Question Title * I want to get more involved! Please follow up with me about ways I can help make the union stronger. Question Title * Please provide your contact information (first name, last name, and email are required fields): First Name * Last Name * Address Apt # City/Town State/Province ZIP/Postal Code Country Email Address (personal email if possible) * Phone Question Title * Job Title (Please select the option that best fits your appointment) Grader Pre-Doctoral Instructor Postdoctoral Scholar Postdoctoral Scholar - Fellow Postdoctoral Scholar - Interim Reader Research Assistant - Graduate Research Assistant - Undergraduate Teaching Assistant - Undergraduate Teaching Assistant - Graduate Training Grant Recipient Staff Assistant (Summer Only) Graduate Research Student Assistant (Hourly) Tutor Unknown Not Currently Employed as an ASE or Postdoc Question Title * Please provide your work information (department is required): Department * Current Degree Program (if student) Month and Year Started at UW Advisor/PI Lab/Office Location (Building and Room) Submit