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I HEREBY APPLY for membership in HGEA, Local 152, AFL-CIO. I understand:

  1. that I must meet HGEA's membership eligibility requirements before membership is approved;
  2. that approved membership will continue irrespective of changes in employment and until I submit written resignation of membership or my membership is terminated by HGEA in accordance with the HGEA Charter and Bylaws;
  3. that I am responsible for notifying HGEA of any changes to the information provided on this form;
  4. and that my effective date of membership is the first day of the current month in which HGEA has received this form.
  5. and that HGEA is not liable or responsible for any benefits or representations offered or made by other providers of any other benefits, programs, etc.

HGEA dues are not tax deductible as charitable contributions for Federal income tax purposes, they may be tax deductible under other provisions of the Internal Revenue Code.

I consent to the collection and use of this information by HGEA and its authorized affiliates and agents. I authorize my employer to disclose to HGEA any information contained in government records necessary for the administration of my membership account. I understand that HGEA does not sell, trade or rent my personal information to others. I certify that the above statements and answers are true and complete to the best of my knowledge and belief.

APPLICABLE TO PAYROLL DEDUCTION PAYORS ONLY: I authorize my employer to deduct, from my payroll, employee organization membership dues and other association benefit payments specified by HGEA. I further authorize HGEA to make changes to cover or cancel the employee organization membership dues and other authorized association benefit payments.

Check here if you agree to the above statements.*

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