United Academics Membership Card


United Academics, AFT Vermont

Membership Form

Name:

Home Address:

City:

State:

Zip:

Telephone (home/cell):

Telephone (work):

Email Address (work):

Email Address (home):

Office Location:

Date Hired:

Job Title:

Department:

Please Check One:


Membership Statement: I hereby request and accept membership in United Academics—AAUP/AFT-VT,
and agree to abide by its Constitution and Bylaws, including payment of member dues. My membership
shall be continuous unless I notify United Academics in writing that I intend to resign, at Box 31, 85
South Prospect St., University of Vermont, Burlington, VT 05405.

→ Initial:

Date:


Dues Authorization: During my employment, I hereby voluntarily authorize and direct UVM to deduct
from my pay each pay period, regardless of whether I am or remain a member of the Union, an amount
equal to dues (which are currently 1% of base salary), subject to provisions of the Collective Bargaining
Agreement between United Academics and the University of Vermont and applicable law. I understand
that I have a right not to join or financially support a labor organization, and I choose to make the
payments agreed to on this form voluntarily.

Revocation Window: This voluntary authorization and assignment shall be irrevocable, regardless of
whether I am or remain a member of the Union, for a period of one year from the date of authorization.
This authorization shall automatically renew from year to year unless I am no longer in the bargaining
unit or I revoke this authorization by sending written notice to the Union by the United States Postal
Service fourteen calendar days prior to the anniversary of the date signed below.

IRS Disclaimer: Payments to the Union are not deductible as charitable donations for federal income tax purposes. However, they may be tax deductible as ordinary and necessary business expenses. 

Telephone Consumer Protection Act Statement: By providing my cell phone number, I understand that the Union and its affiliates may use automated calling technologies and/or text message me on my cell phone on a periodic basis, and that I can unsubscribe from these messages. The Union will never charge for text message alerts; carrier message and data rates may apply to such texts.

→ Initial:

Date:

Leave this empty:

Signature arrow sign here


Signature Certificate
Document name: United Academics Membership Card
lock iconUnique Document ID: cb1983a146987ab14d512f6cf0ceb8d66758a6a8
Timestamp Audit
August 17, 2022 12:33 pm ESTUnited Academics Membership Card Uploaded by Katlyn Morris - katlyn.morris@aftvermont.org IP 65.183.144.83, 172.70.230.42
August 17, 2022 12:36 pm EST Document owner james.richmond@aftvermont.org has handed over this document to keith.brunner@aftvermont.org 2022-08-17 12:36:55 - 65.183.144.83, 172.70.110.190
August 18, 2022 9:40 am EST Document owner keith.brunner@aftvermont.org has handed over this document to katlyn.morris@aftvermont.org 2022-08-18 09:40:33 - 65.183.144.83, 172.70.230.146