I hereby request and accept membership in UE Local 896 COGS and authorize it to represent me and in my behalf to negotiate and conclude all agreements as to hours of labor, wages, and all other conditions of employment.

I authorize and direct the Union to withdraw payment monthly, while I am employed by the Employer in the Unit covered by the collective bargaining agreement, and irrespective of my membership status in the Union, an amount equal to UE membership dues, and an initiation fee as designated by the Union and to promptly remit the same to UE Local 896, United Electrical, Radio & Machine Workers of America (UE). I understand that membership and the periodic payment of dues are not a condition of employment.

This assignment and authorization shall continue until revoked and cannot be revoked for a period of one (1) year from the date appearing above or until the expiration date of the current collective bargaining agreement between the Employer and the Union, whichever comes sooner, and shall be irrevocable for each succeeding year thereafter unless it is revoked by me within the ten (10) days preceding the end of any such period of irrevocability. Such notice of revocation shall become effective respecting the dues for the month following the month in which such written notice is given.

Revocation shall be effective only if I give UE Local 896, United Electrical, Radio & Machine Workers of America (UE) written notice and it is received or postmarked during the period specified above.