Membership Card Social share icons You must have JavaScript enabled to use this form. Leave this field blank First Name Middle Initial Last Name Home Street Address Apartment, Suite, etc. City State - Select -AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Birthdate Registered Voter (Y/N) Yes No Employer Employer - Select -State of NevadaNSHEStorey CountyCity of West WendoverOther… Enter other… Department Job Classification Worksite EIN Date of Hire Personal Email Cell Phone † † By providing my cell phone number I consent to receive calls (including recorded or autodialed calls, or texts) at that number from AFSCME and its affiliated labor, political and charitable organizations on any subject matter. My carrier’s rates may apply. I may modify my preferences at https://www.afscme.org/tcpa. By providing my cell phone number I consent to receive calls (including recorded or autodialed calls, or texts) at that number from AFSCME and its affiliated labor, political and charitable organizations on any subject matter. My carrier’s rates may apply. Authorization I hereby choose to become a member of AFSCME, and to abide by its constitution and bylaws. By signing below, I authorize my employer to deduct from my pay the membership dues and benefit program payments established by AFSCME Local 4041 currently and as may be modified in the future. Membership dues are currently 1% of base compensation pay before taxes per pay period; probationary employees dues are ½% (and are not tax-deductible as charitable contributions). This authorization will automatically renew from year to year, and without regard to whether I remain a member of the union, unless I give written notice to AFSCME Local 4041 and the State Controller of my decision to revoke this authorization during the two weeks preceding each anniversary date of this authorization. Signature Reset Please sign using your mouse or your finger on a touchscreen. Sign Your Card
