Become a CWA 1104 RA Union Member

I hereby apply for membership in the Communications Workers of America Local 1104, Research Assistants Union. I designate CWA Local 1104 RA Union as my representative for the purpose of collective bargaining on matters of hours, wages and other terms and conditions of employment.

First Name *

Last Name *

Dept./Work Area *

Job Title *

Building & Office Number *

Address *

Address Line 2

City *

State *

Postal/Zip Code *

Personal Email Address *

Please use your personal email address. DO NOT use your work email, thank you.

Cell Phone Number

Authorize *

Become A Member

Be An Agency Fee Payer

I hereby authorize The Research Foundation to deduct from the compensation (including disability benefits or vacation payments) due me each month an amount equal to regular monthly Union dues, certified in writing to the Company by the Secretary-Treasurer of the Communications Workers of America, or his/her duly constituted agent. Each amount so deducted shall be remitted to the Secretary-Treasurer of the Communications Workers of America, or his/her duly constituted agent. If for any reason the Company fails to make a deduction, I authorize the Company to make such deduction in a subsequent payroll period. This authorization is voluntarily made and is neither conditioned on my present or future membership in the Union, nor is it to be considered as a quid pro quo for membership. This authorization shall continue in effect until canceled by written notice signed by me and individually sent to the Company and to the Union. This cancellation of authorization must be postmarked during the fourteen (14) day period prior to each anniversary date of the current or any subsequent Collective Bargaining Agreement, or during the fourteen (14) day period prior to the termination of the current or any subsequent Collective Bargaining Agreement.

Digital Signature

First Name *

Last Name *

Date of Authorization *

Month

Day

Year

SUNY Campus *

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