I hereby request and accept membership in the Communications Workers of America and, when accepted by Local 1104, agree to be bound by the Constitution on the Union and Amendments thereto and Rules and Regulations now in effect or subsequently enacted by the Union and/or Local 1104.

By this application, I authorize the Union to act as my exclusive bargaining representative for the purpose of collective bargaining with respect to wages, salaries, hours, and other terms and conditions of employment.

Subject to New York State Civil Service Law §208 and in all amendments or supplements thereto hereafter issued, I hereby authorize my Employer to deduct in each regular payroll from my salary/wages my Union's current dues amount and any rule authorized dues increase, in accordance with the terms of collective bargaining agreement between my Union and my Employer. You are further authorized to make any necessary changes and adjustments in said deductions as may be necessary from time to time because of duly authorized changes in the amount of such dues. I further understand that if I wish to revoke this authorization, I must do so in writing to my Employer and the Union.