I hereby apply for membership in the United Food and Commercial Workers Union 1439, and authorize the Union to represent me for the purposes of collective bargaining.

I hereby authorize and direct my employer to deduct from my wages, each and every month, dues and/or initiation fees which I am required to pay as a condition of maintaining membership in good standing of United Food and Commercial Workers Union Local 1439. I direct that the same be forwarded each month to the Union office at 1719 N. Atlantic, Spokane, WA 99205.
This authorization and direction shall be irrevocable for a period of one (1) year or until the termination of the collection bargaining agreement between my Employer and the Union, whichever occurs sooner. This authorization and direction shall be automatically renewed, and shall be irrevocable for the successive period of one (1) year each or for the period of each succeeding bargaining agreement between my Employer and the Union, unless written notice is given by me to my Employer and the Union not more than thirty (30) days and not less than ten (10) days prior to the expiration of each year period, or the expiration of each agreement between my Employer and the Union, whichever occurs sooner.

I hereby authorize and direct the Company/Employer named above to deduct from my wages the sum of $1.00 per week for all compensated pay periods as your employee and remit seventy-five percent (75%) of the amount to the UFCW Local 1439 Active Ballot Club (ABC) and twenty-five percent (25%) to the UFCW International Union ABC.

This authorization is voluntarily made on my specific understanding that:

• The signing of this authorization form and the making of these voluntary contributions are not conditions of membership in UFCW Local 1439 or employment by my employer;
• I may choose not to contribute without fear of retaliation;
• UFCW Local 1439 ABC Fund will use the money they receive to make contributions to and expenditures only for candidates for offices appearing on the ballot in Washington, Idaho and Oregon that support working families.

This authorization shall remain in full force and effect until revoked in writing by me.

I understand that this amount is only a suggestion and that I may contribute a greater or lesser amount through methods other than payroll deduction. I also understand that UFCW Local 1439 will not favor or disfavor anyone because of their decision to contribute or not to contribute, or because of the amount of their contribution. I further understand that contributions or gifts to UFCW Local 1439 ABD Fund are not deductible as charitable contributions for federal tax purposes.