AFT KY 1360 - Membership Application and Dues Authorization

AFT KY 1360 has been established as a local affiliate (#1360) of the American Federation of Teachers (AFT) to advance the interest of faculty/staff working in the Kentucky Community and Technical College System. I support AFT KY 1360 as a representative for KCTCS employees and wish to join the union.

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First Name *

Middle Name

Last Name *

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Mailing Country *

Mailing Address *

Mailing Suite

Mailing City *

Mailing State *

Mailing Zip Code *

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Home Phone

Mobile Phone

Work Phone

Preferred Phones

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Personal E-mail *

Work E-mail

Work Location

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KCTCS employee ID number *

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Job Title

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CollegeCampus *

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Life Insurance Beneficiary

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Recruited by

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A small amount of your annual dues will be designated to FSA's political action fund to support state legislators who have helped FSA. Initial below if you do not want to contribute to this fund. Enter initials below.

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Initials

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As an employee of (KCTCS), you can take advantage of the convenience of having your organization dues automatically deducted from your payroll check. Questions You May Have About the Dues Deduction Program 1. How do I know that a deduction has been made to my payroll check? You will receive an earnings statement on that shows details of your deduction. 2. What do I do if I want to make a change once I am in the program? To make a change, you must complete a new Authorization Agreement for Deduction. The change will probably take one month, during which time you may need to make payments directly yourself. 3. When will the deduction begin if I choose to participate? Normally, two pay periods after the Payroll Department receives your "Authorization Agreement for Deduction." On the first payday after the form is received, a prenotification is sent to the financial institution of the organization to receive the dues/contribution to insure the accuracy of the bank and account numbers. After the prenotification has been successfully completed deductions will begin on the next payday. 4. If I choose to participate, will all dues/contributions be automatically deducted? Yes, if they are approved by KCTCS.

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Initials - Confirm I have read the above information *

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Select your membership category

Dues Amount

$0.00

Total * draft

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Authorize

I hereby authorize my payroll officer to deduct my AFT KY 1360 monthly dues in accordance with the dues structure of the American Federation of Teachers KY Local 1360.

By providing the information on this form, I authorize AFT KY 1360 - Local 01360 and the American Federation of Teachers (AFT) to deduct dues for membership per the above information and in accordance with the AFT KY 1360 - Local 01360 constitution, the state constitution and the AFT constitution. Dues payments are not deductible as charitable contributions for federal income tax purposes, but a portion thereof may be deductible as a miscellaneous itemized deduction. The dues amount may change if authorized according to the requirements of the local, state or national constitutions. If this happens, I authorize my bank or credit card to adjust my payment when notified by AFT KY 1360 - Local 01360. I agree this authorization remains in effect until terminated in writing by me or until AFT KY 1360 - Local 01360 is given written notification of my separation from my employer and/or the bargaining unit.

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