UPEC Local 792

UNITED PUBLIC EMPLOYEES OF CALIFORNIA, LOCAL 792

Laborers’ International Union of North America
DUES / FEES AUTHORIZATION FORM

Completion of this form and the signing of my name constitutes authorization for dues / fees to be paid to the United Public Employees of California, Local 792, LiUNA. Authorization shall include deduction by my Employer of union dues / fees and shall remain valid and enforceable until revoked by me in writing, signed and dated on a form provided by UPEC and submitted in the appropriate period.

I agree that this authorization shall automatically renew, unless written notice is given by me to UPEC on a form provided by UPEC in the thirty (30) day period prior to the expiration of the MOU between my Employer and UPEC. In the event no MOU is in effect, the period to provide UPEC a notice of cancellation shall be in the month of June. This dues / fees authorization shall supersede a union security clause contained in the MOU that applies to my position.

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ALL INFORMATION IS MANDATORY PLEASE FILL OUT COMPLETELY

First Name *

Last Name *

Date *

Mailing Address *

City *

State *

Zip *

Social Security Number *

Date of Birth *

Personal Email Address *

Title/Job Classification *

Home Phone *

Cell Phone *

Work Phone *

I AGREE TO ACCEPT TEXTS FROM UPEC/LiUNA

Agree

Department *

Employer *

Bargaining Unit *

Work Location Address *

Should you have any questions, please contact the Union Office at (530) 245-1890.
2195 Larkspur Lane Suite 214, Redding, CA 96002 www.upec792.com

DUES / FEES DEDUCTION AUTHORIZATION - PLEASE SUBMIT ENTIRE FORM TO UPEC

By my signature below, I authorize payroll deductions to be made from my payroll warrant for union dues or voluntary representation fees, which shall remain valid and enforceable until revoked by me in writing, as prescribed above. Any refund of incorrect/overpaid dues / fees will be limited to 3 months.

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Date *

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