• By submitting this form, you are affixing an electronic signature to this document.

• I hereby assign to IBEW Local 245, International Brotherhood of Electrical Workers, AFL-CIO, from any wages earned or to be earned by me as a member, a flat rate per month for initiation fees and working dues, or such amounts as may hereafter be established by the Union and become due to it, as my membership dues in said Union. I authorize and direct you to deduct such amounts each month from my pay and to remit the same to the Union.

• I further assign and transfer into IBEW Local 245, out of wages to be earned by me as a result of my employment, any such monthly Local Union dues now owing by me for a period not to exceed three (3) months prior to this date.

• This assignment, authorization and directive shall become operative contemporaneously with the effective date of any new collective bargaining agreement between the Employer and the Union, which shall succeed the current collective bargaining agreement between the same parties.

• This assignment, authorization and directive shall be revocable by me at any time, but shall be in full force and effect until revoked by me by giving written notice to both the Employer and the Local Union, such notice to be signed by me and mailed via certified mail to the Employer and the Local Union.

• Fees, dues and assessments covered by this authorization are not deductible as charitable contributions for federal income tax purposes.

PLEASE BE SURE TO RE-SIGN EVERY 30 CALENDAR DAYS!!