Glendale College Guild, AFT Local 2276 Your Faculty Labor Union Membership Application Form 1500 North Verdugo Road Glendale, CA 91208

Membership is not automatic! To become a Guild member, you need to sign this membership form. Membership benefits include:

 Discounts through the American Federation of Teachers (AFT) as well as free legal advice  FREE Life Insurance for 1 year for new AFT members FOR OFFICE USE ONLY  The right to vote on Guild issues and the right to be a candidate in officer elections  Influence on teacher-related legislative issues DBASE ______

 Discounts through Recreation Connection NMP ______

 FREE Occupational Liability Insurance up to $1,000,000 INS ______

 Membership in a 1.6 million-member professional organization P.Q.E ______

YOUR MEMBERSHIP BECOMES VALID ON THE FIRST DAY OF DUES PAYMENT Dues are currently 1% of all income from positions represented by the Guild.

______Last Name First Name M.I. Employee ID

______Home Address City State Zip

Home Phone: ( ) ______Work Phone: ( ) ______

Non-Work email: Division

Mailbox Location: mailroom Verdugo Campus mailroom Garfield Campus

Other (please explain how you receive college mail. Example: dept mailbox)

Status: ____ Full Time Part Time

I hereby request and voluntarily authorize my employer to deduct from my earnings and to pay over to Glendale College Guild an amount equal to the regular monthly dues uniformly applicable to members of the Guild. This authorization shall remain in effect and shall be irrevocable unless I revoke it by sending written notice to Glendale College Guild during the period not less than thirty (30) days and not more than forty-five (45) days before 1) the annual anniversary date of this agreement or 2) the date of termination of the applicable contract between the employer and Glendale College Guild, whichever occurs sooner. This authorization shall be automatically renewed as an irrevocable check-off from year to year unless I revoke it in writing during the window period, irrespective of my membership in Glendale College Guild. Dues paid to Glendale College Guild may not be deductible for federal income tax purposes; however, under limited circumstances, dues may qualify as a business expense.

Signature: ______Today’s Date: ______

Professors for Quality Education (PQE) The Guild has a political action committee, whose primary focus is the college’s Board of Trustees. Many members of the campus community contribute to PQE through payroll deductions. Won’t you? I authorize payroll deduction for PQE $5 monthly for full-time faculty or $2 monthly for part-time faculty by writing my initials here. This authorization will remain in effect until I revoke it by sending written notice to Glendale College Guild, and shall be effective as of my next pay warrant. This authorization shall be automatically renewed as an irrevocable check-off from year to year unless I revoke it in writing, irrespective of my membership in Glendale College Guild. Contributions made to PQE may not be deductible for federal income tax purposes. Initials: ______You may authorize a higher monthly amount by writing the amount here: $______Initials: _____.

Fold along lines and staple and return in USPS Mail .

Postage Stamp

ATTN: David Hassett, Operations Officer GLENDALE COLLEGE GUILD 1500 NORTH VERDUGO ROAD GLENDALE, CA 91208