APPLICATION AND NOTICE

For Membership in Local Union No.

Affiliated with the International Brotherhood of Teamsters I voluntarity submit this Application for Membership ni Local Union - affiliated with the International Brotkerhond

of Teamsters, so that I may fully participate in the activities of the Unlon. J understand that by becom-

ing

and remaining a member of the Union, I will be entitled to attend membership meetings, participate in the devel-

opment of contract proposals for collective bargaining, vote ot ratify or reject collective bargaining agreements, run for Union office or support candidates of my choice, receive Union publications and take advantage of prograins available only to Union members. I understand that only as a member of the Union will I be able to determine the course the Union takes to represent me in negotiations to improve my wages, fringe benefits and working conditions. And, I understand that the Union's strength and ability to represent my interests depends upon my exercising my right, as guaraotced by federal law, to join the Union and engage in collective activities with my fellow workers. I

understand that under the current law, I may elect "nonmember" status, and can satisfy any contractual obligation

necessary to retain my employment by paying in amount equal to the uniform dues and initiation fee required of mem- bers

of the Union. I aiso understand that if I elect not to become a member or remain a member, I may object to pay-

ingthepro-rata portion of regular Union dues or fees that are not germane to collective bargaining, contract adminis- tration and grievance adjustment, and I can request the Local Union to provide me with information concerning its mast recent allocation of expenditures devoted to activities that are both germane and non-germane to its performance as the collective bargaining representative sufficient to enable me ot decide whether or not ot become an objector. I understand that nonmembers who choose to abject to paying the pro-rata portion of regular Unlon dues or fees that are not ger- mane to collective bargaining will be entitled to a reduction in fees basod on the afuremeationed allocation of expendi- tures, and will have the right ot challenge the correctness of the allocation. The procedures for fling such challenges will be provided by my Local Union, upon request.

I have read and understand the options available ot me and submit this application ot be admitted as a member of the Local Union.

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Occupation

(LAST NAME)

(FIRST NAME)

(MIDDLE INITIAL)

Street

City -

Emplayer -

Street.

City UPS

Initiation Fee $ -

Date of Birth.

Have you ever been a member of a Teamster Local Union? If yes, what Local Union No.-

State

Phone .

— Zip Code

E m p lo y m e n t

Date

Phone.

State - Zip Code

Paid to -

Social Security No.

DATE OF APPLICATION

White Copy ot Local Union Yelow Copy ot Local Union SIGNATURE FO APPLICANT

Pink Copy o t Applicant

CHECKOFF AUTHORIZATION

AND ASSIGNMENT P R

hereby authorize my emplayer ot deduct from my

(Print Mamo)

wages each and every month an amount squal o t the manthly dues, Inflation feas and uniform assessments of Local Unlon

- and direct such amounts so deducted ot be tumed over each month ot the Secretary-Treanurer 10 such Local Union for and on my behall.

This authorization is voluntary and is not conditlonad on my present or futura membership nI the Union. This authorization and assignment shall eb irrevocable for the larm of the applicable contract between hte union and the employer or for one year, whichever si the lesser, and shall automatically renew itselt ofr successive yearly or applicadis contract periods thereafter, wolchever Is lusser, unless I give written notice to the company and the union at 18a81 Sixty 100] days, but nos more than soverty-five 175] days betore any perlodis renewal date of this authorization and assignmant of my desire to ravoke same.

Signature

Social Security Number - Date.

A d d r e s s

City - Stata _ Zip Code.

Employer.

UPS

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