UAW Local 4121 Membership and Dues Deduction

Our strong majority membership helps us win improvements at UW and beyond.

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* 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.

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* 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

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* Job Title (Please select the option that best fits your appointment)

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* Please provide your work information:

Current Degree Program (if student)

Month and Year Started at UW

Advisor/PI

Lab/Office Location (Building and Room)

Employee ID (if known)