UE Local 1122 - NUGW Digital Non-Member Card

Only use this form if you DO NOT wish to join UE Local 1122 - NUGW, the union for graduate employees at Northwestern. If you wish to pay agency fees in lieu of union membership, please fill out the form below. I understand that in being an agency fee payer I forgo all rights as a member of the union, including the right to attend union meetings, run for union office, and vote on contracts. NOTE: Business email means Northwestern email. Please only enter your Northwestern email in that field

Fields marked with an asterisk (*) are required

First name

Last name

Business email

Personal email

Cell phone Preferred phone

Northwestern NetID

Home address

I do not wish to become a member of UE Local 1122. In lieu of such membership, I agree to pay to the Union an agency fee. The amount of such agency fee shall be established by the Union in accordance with applicable law, but in no event shall such fee exceed full union dues. You are hereby authorized and directed to deduct from my monthly pay, an amount equivalent to dues, fees, assessments and initiation fees, as shall be certified by the United Electrical, Radio & Machine Workers of America (UE) Local 1122 and remit the same to the UE. This authorization and assignment is voluntarily made as an administrative convenience to facilitate payment of dues, fees, assessments, and initiation fees that I have voluntarily agreed to make even in the absence of membership in the UE and is not contingent upon my future membership in the UE. This authorization and assignment shall be irrevocable for a period of one (1) year from the date I sign this card or until the end of the current collective bargaining agreement between my Employer, its successors (including, but not limited to, Burns successors) and assigns, and the Union, whichever occurs sooner, and from year to year thereafter, unless I give the Employer and the Union written notice to stop deducting payments under this agreement, postmarked within seven (7) days before the end of the one year period or postmarked within seven (7) days before the end of the collective bargaining agreement. I understand that the Employer will stop deductions from my wages, and the Union will stop receiving them, effective the month after the month in which written notice of revocation is given. Revocation shall be effective only if I give the Employer and UE Local 1122 written notice, and it is received or postmarked during the period specified above. This authorization will remain in effect in the event that I am laid off, leave work on a leave of absence, or separate from employment with my present Employer. I authorize deductions to resume upon the resumption of employment as a new hire or otherwise.

Signature clear

Use your mouse (or your finger on a phone or tablet) to enter your signature above.