VSC Faculty Federation Membership Form



Vermont Federation of Nurses and Health Professionals (VFNHP), AFT Vermont

Membership Form

Printed Name:

Address:

City, State, Zip:

Cell Phone:

Home Phone:

Work Phone:

Email (non-employer):

Worksite:

Job Title:


Membership Statement: I hereby apply for membership in the Union and agree to abide by its Constitution and Bylaws. I authorize the Union to act as my exclusive representative in collective bargaining over wages, hours and other terms and conditions of employment with my employer. My membership in AFT Vermont and my Local Union shall be continuous unless I notify my local president in writing that I intend to resign.

→ Initial:

Date:


Dues Authorization: During my employment, I hereby agree to pay an amount equal to dues as certified by the Union regardless of whether I am or remain a Union member. I also authorize my employer to deduct from my pay each pay period that amount that is equal to dues and to remit such amount monthly to the Union. 

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, or until the termination date of the collective bargaining agreement between the Union and the Employer, whichever occurs sooner, and shall automatically renew from year to year unless I revoke this authorization by sending written notice by the United States Postal Service to the Union postmarked fourteen calendar days prior to the anniversary of the date signed above or by sending written notice by the United States Postal Service to the Union upon the termination of the collective bargaining agreement.

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.

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Date:


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Signature Certificate
Document name: VSC Faculty Federation Membership Form
lock iconUnique Document ID: 8640fd76f21d51f8774f08084986a988d457ee0b
Timestamp Audit
March 10, 2021 2:35 pm EDTVSC Faculty Federation Membership Form Uploaded by VSC - AFT Vermont - [email protected] IP 69.5.117.7
March 10, 2021 4:29 pm EDT Document owner [email protected] has handed over this document to [email protected] 2021-03-10 16:29:59 - 45.133.182.252