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AFT Utah - Application/Dues Withholdings
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MEMBERSHIP APPLICATION AND AUTHORIZATION OF DUES WITHHOLDINGS
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Last 4 Social Security Number
First Name
*
Middle Name
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United States of America
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*
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*
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Date of Birth
Date
E.g., 2025-01-13
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preferred
preferred
preferred
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*
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Worksite Location
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Employee ID
*
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Position
*
payroll-deduction
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Select your membership category
Select your membership category
Dues for salary ranges of $40,000 and above
Dues for salary ranges between $16,599 to $39,999
Dues for salary ranges between $10,079 and $16,598
Dues for salary ranges of $10,078 and below
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Authorize
I agree to be a member of AFT Utah authorize AFT Utah to represent me to the fullest extent of the law, and accept the terms of the agreement below.
I hearby authorize my employer to withhold from my salary a sum equal to the annual dues of AFT Utah as determined by my local assignee. This authorization will remain in effect until further notice - unless changed or terminated by me on thirty days written notice to AFT Utah. Dues paid to AFT Utah may not be deductible for federal income tax purposes; however, under limited circumstances, dues may qualify as a business expense. These dues shall be deducted monthly in equal payments. I understand my dues will provide liability and Accidental Death & Dismemberment insurance, as well as all related AFT publications and union benefits.
Print your name
Date
Date
E.g., 2025-01-13
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