TEAMSTERS LOCAL 763

APPLICATION AND NOTICE

For Membership in Teamsters Local Union No. 763

Affiliated with the International Brotherhood of Teamsters

Employer *

Hire Date *

Classification

Hourly Rate

I voluntarily submit this Application for Membership in Local Union 763, affiliated with the International Brotherhood of Teamsters, so that I may fully participate in the activities of the Union. I understand that by becoming and remaining a member of the Union, I will be entitled to attend membership meetings, participate in the development of contract proposals for collective bargaining, vote to ratify or reject collective bargaining agreements, run for Union office or support candidates of my choice, receive Union publications and take advantage of programs 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 guaranteed 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 an amount equal to the uniform dues and initiation fee required of members of the Union. I also understand that if I elect not to become a member or remain a member, I may object to paying the pro- rata portion of regular Union dues or fees that are not germane to collective bargaining contract administration and grievance adjustment, and I can request the Local Union to provide me with information concerning its most 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 to decide whether or not to become an objector. I understand that nonmembers who choose to object to paying the pro-rata portion of regular Union dues or fees that are not germane to collective bargaining will be entitled to reduction in fees based on the aforementioned allocation of expenditures, and will have the right to challenge the correctness of the allocation. The procedures for filing such challenges will be provided by my Local Union 763, upon request.

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

Last Name *

First Name *

Middle Initial

Phone *

Address *

City *

State *

Zip Code *

Initiation Fee $

Paid to:

Local 763

Date of Birth

Social Security No.

Have you ever been a member of a Teamster Local Union:

If yes, what Local Union No.

Email *

By signing your name in the signature box(s), you are signing this Agreement electronically. You agree and consent to using your electronic signature for this application document and that it is the legal equivalent of your handwritten signature. You further agree that your signature on this application document is as valid as if you signed the document in writing. You are also confirming that you are the person authorized to make this application and that it is your intent to do so through electronic signature. Your consent and confirmation of your intent to be bound by this electronic signature only applies to this application document. You may request a hard copy of your signed application for your records. You can opt-out of signing this application electronically by notifying Teamsters Local 763 that you wish to sign the form in writing via ink (hard copy).

DATE OF APPLICATION *

Signature *

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(CHECKOFF AUTHORIZATION AND ASSIGNMENT)