4Cs University of Hartford Dues Deduction "*" indicates required fields To be a member, you need to sign a membership form. The amount you pay is the same: 1.2%* of salary whether you are a fee payor or a member. But membership gives you a greater voice in decisions that affect your job. For example, only members can vote in union elections as well as create priorities for contract negotiations. Member rights are set forth in the 4Cs Constitution available on our website at www.the4cs.org. You also have the right to be a non-member of the 4Cs. If you do not join, the 4Cs will fairly represent you and you will be required to pay a fair share payment to cover the costs of collective bargaining. As a non-member, you are “Fee Payer” and the amount you pay is equal to the same as member dues. There may be possible reductions of the fair share payment for the costs of union activities unrelated to collective bargaining.First Name*Last Name*Street AddressStreet Address 2Zip Code*CityState/ProvincePlease select…AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificEmail* Home PhoneMobile PhoneBy submitting your cell phone number you are agreeing to receive periodic text messages from this organization. Message and data rates may apply. Text HELP for more information. Text STOP to stop receiving messages. Additional InformationWhat is your job classification?Please select…Regular Part-Time FacultyAdjunctCommunity DivisionOtherOtherMembership Authorization Yes, I want to join with my fellow employees and become a member of the 4Cs, SEIU Local 1973 (“4Cs”). I hereby request and voluntarily accept membership in 4Cs and I agree to abide by its Constitution and Bylaws and by the Service Employees International Union Constitution and Bylaws. I authorize 4Cs to act as my exclusive representative in collective bargaining over wages, benefits, and other terms and conditions of employment with my employer. Dues Deduction & Checkoff Effective immediately, I request and authorize the 4Cs to have deducted from my earnings each payroll period an amount sufficient to provide for regular payment of dues as certified by the Union. This amount shall be paid to the 4Cs and represents the payment of my union dues. The dues payment may be terminated by providing 30 days’ written notice via U.S. mail to the 4Cs.Signature*CommentsThis field is for validation purposes and should be left unchanged.
