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**By providing my cell phone number, I understand that HGEA and its affiliates may use automated calling technologies and/or text message me on my cell phone on a periodic basis. The HGEA will not charge for text message alerts; carrier message and data rates may apply to such texts.

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I HEREBY APPLY for membership in the Hawaii Government Employees Association, AFSCME Local 152, AFL-CIO (hereafter “HGEA”) and I agree to abide by its Constitution and Bylaws. I authorize HGEA and its successor or assign to act as my exclusive bargaining representative for purposes of collective bargaining with respect to wages, hours and other terms and conditions of employment with my Employer.

Effective immediately, I hereby voluntarily authorize and direct my Employer to deduct from my pay each pay period, regardless of whether I am or remain a member of HGEA, the amount of dues certified by HGEA, and as they may be adjusted periodically by HGEA, and to authorize my Employer to remit such amount to HGEA.

This voluntary authorization and assignment shall be irrevocable, regardless of whether I am or remain a member of HGEA, for a period of one year from the date of execution, and for year to year thereafter unless I give HGEA written notice of revocation within thirty (30) days before the anniversary of the date of execution. This card supersedes any prior check-off authorization card I signed.

I recognize that my authorization of dues deductions, and the continuation of such authorization from one year to the next, is voluntary and not a condition of my employment.

Payments to HGEA are not deductible as charitable donations for federal income tax purposes. However, state law may extend favored tax treatment.

Check here if you agree to the above statements.*

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