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Concordia Federation of Teachers & School Employees
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Membership Application and Authorization for Payroll Deduction
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First Name
*
Middle Name
Last Name
*
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Mailing Country
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United States of America
Mailing Address
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Mailing City
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Mailing State
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- Select -
Alabama
Alaska
Arizona
Arkansas
California
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Connecticut
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District of Columbia
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Maine
Maryland
Massachusetts
Michigan
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New Hampshire
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New York
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Ohio
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Oregon
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Rhode Island
South Carolina
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Tennessee
Texas
Utah
Vermont
Virginia
US Virgin Island
Washington
West Virginia
Wisconsin
Wyoming
Mailing Zip Code
*
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Mobile Phone
Preferred Phones
preferred
Personal E-mail
*
Worksite Location
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Date
*
Date
E.g., 2024-12-03
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Employee ID #
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Select your membership category
Select your membership category
Teacher
Support
Dues Amount
$0.00
Total
* draft
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Authorize
I agree to be a member of Concordia Federation of Teachers, authorize Concordia Federation of Teachers to represent me to the fullest extent of the law, and authorize and request that my employer deduct from my earnings in each pay period the applicable membership dues. I accept the terms of the agreement below.
I hereby apply for and accept membership in the Concordia Federation of Teachers. I agree to abide by the Federation’s Constitution and Bylaws and all Rules and Regulations. I authorize the Federation to act as my exclusive representative in collective bargaining over wages, benefits, and other terms and conditions of employment. I hereby authorize and request that you deduct and withhold from my earnings in each pay period the applicable membership dues, and any duly authorized change in that amount, to the Concordia Federation of Teachers as prescribed by the Federation’s Constitution and By-Laws, and to remit said dues to the Federation. This authorization is voluntary, and the dues deduction remains in effect from year to year until revoked by me through written notice to my employer, with a copy to the Federation.
Print your name
Date
Date
E.g., 2024-12-03
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