Lodge 92 Labor Services

FOP LODGE 92 Labor Services
Membership Application
PO BOX 683, Blue Bell, PA 19422

Membership Card

Application

YES! I want to join my fellow employees and become a member of FOP Lodge 92 Labor Services. I request and voluntarily authorize my employer , The Commonwealth of Pennsylvania to deduct from my earnings and pay an amount equal to Lodge 92’s regular dues. This dues deduction authorization shall remain in effect, regardless of whether I remain a member of the Union, for a period of one year from the date of execution and will renew automatically from year to year as long as my employment continues, unless I revoke it by providing notice to Lodge 92 Labor Services via U.S. mail within the 30-day period before the anniversary date of this agreement. I acknowledge that my dues deduction authorization is a contractual agreement between myself, as a bargaining unit employee, and FOP Lodge 92 Labor Services, separate from any statutory provisions. Authorization is not a condition of employment, and I can decline to agree to it without reprisal.

First Name *

Middle Initial

Last Name *

Home Address *

City *

State *

Postal Code *

Email *

Cell Phone *

Home Phone

Last 4 SSN *

Employee Number *

Birth Date *

Hire Date *

Agency *

Job Title *

Work Location

Are you currently a Member of an FOP Lodge? *

Authorize Agreement *

BY SIGNING THIS DOCUMENT ELECTRONICALLY, I CONSENT TO ENTER INTO THIS AGREEMENT FOR AUTHORIZATION OF DUES DEDUCTION WITH THE LOCAL UNION. I HAVE READ, UNDERSTAND, AND SUBMIT THIS APPLICATION TO BE ADMITTED AS A MEMBER OF THE FOP LODGE 92 LABOR SERVICES UNION.

Agree

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