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Pennsylvania Joint Board Union Membership Card

,now employed by

(Last Name,

First Name,

Middle Initial)

(Name of Employer)

hereby request and accept membership in the Pennsylvania Joint Board , Workers United, SEIU. I agree to abide and be bound by the constitution and by-laws of the Pennsylvania Joint Board and I authorize the Pennsylvania Joint Board to act exclusively as my agent for the purpose of collective bargaining.

I, hereby authorize and direct my Employer, or its successor, or any Employer, for which I work, to deduct from my wages membership dues (which include periodic dues, initiation fees and assessments) which I am obliged to pay the Union or its designee pursuant to the provisions of any current or future collective bargaining agreement.

Contributions or gifts to the Pennsylvania Joint Board are not tax deductible as charitable contributions for Federal Income tax purposes. This authorization shall remain in effect and shall be irrevocble unless I revoke it by sending written notice via U.S. mail to both the employer and Pennsylvania Joint Board during the period not less than thirty(30) days and not more than forty-five(45) days before the annual anniversary date of this agreement or the date of termination of the applicable contract between the employer and the Pennsylvania Joint Board , whichever occurts sooner. This authorozation shall be automatically renewed as an irrevocable check-off from yeat to year unless I revoke it in writing during the window period, even if I have resigned my membership in the Pennsylvania Joint Board.

Home Address

City

State

Zip

Date of Birth

Gender

Email Address*

Home Phone

Cell Phone*

last 4 digits of Soc Sec #

Work Location

Job Title

Date of Hire

BY PROVIDING MY PHONE NUMBER AND EMAIL ADDRESS I UNDERSTAND THAT THE PA JOINT BOARD, WORKERS UNITED, SEIU AND AFFILIATES MAY USE AUTOMATED CALLING TECHNOLOGIES, EMAILS, AND/OR TEXT MESSAGES ON A CELLULAR DEVICE TO CONTACT ME ON A PERIODIC BASIS. THE PA JOINT BOARD WILL NEVER CHARGE ME FOR TEXT MESSAGE ALERTS. CARRIER MESSAGES AND DATA RATES MAY APPLY TO SUCH ALERTS

TEXT STOP TO 787753 TO STOP RECEIVING MESSAGES. TEXT HELP TO 787753 FOR MORE INFORMATION.

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1. Electronic Signature Agreement. By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Agreement. By selecting "I Accept" you consent to be legally bound by this Agreement's terms and conditions. You further agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action, or in accessing or making any transaction regarding any agreement, acknowledgement, consent terms, disclosures or conditions constitutes your signature (hereafter referred to as "eSignature"), acceptance and agreement as if actually signed by you in writing. You also agree that no certification authority or other third-party verification is necessary to validate your eSignature and that the lack of such certification or third-party verification will not in any way affect the enforceability of your eSignature or any resulting agreement between you and Laundry, Distribution and Food Service Joint Board, Workers United/SEIU (LDFS JB). You also represent that you are authorized to enter into this Agreement for all persons who are authorized to access any of your account information and that such persons will be bound by the terms of this Agreement.

2. Consent to Electronic Delivery. You specifically agree to receive and/or obtain any and all Laundry, Distribution and Food Service Joint Board, Workers United/SEIU (LDFS JB) related "Electronic Communications" (defined below) via email or other electronic delivery. The term "Electronic Communications" includes, but is not limited to, any and all current and future notices and/or disclosures that various federal and/or state laws or regulations require that we provide to you, as well as such other documents, statements, data, records and any other communications regarding your account information with Laundry, Distribution and Food Service Joint Board, Workers United/SEIU (LDFS JB). You acknowledge that, for your records, you are able to retain Electronic Communications by printing and/or downloading and saving this Agreement and any other agreements and Electronic Communications, documents, or records that you agree to use with your eSignature. You accept Electronic Communications from Laundry, Distribution and Food Service Joint Board, Workers United/SEIU (LDFS JB) as reasonable and proper notice, for the purpose of any and all laws, rules, and regulations, and agree that such electronic form fully satisfies any requirement that such communications be provided to you in writing or in a form that you may keep.

3. Paper Version of Electronic Communications. You may request a free paper version of an Electronic Communication at any time. To request a paper copy of an Electronic Communication, contact us at (973)735-6464 or via the Laundry, Distribution and Food Service Joint Board, Workers United/SEIU (LDFS JB) Member Portal at http://ldfsunion.org/.

4. Revocation of Electronic Delivery. You have the right to withdraw your consent to receive and/or obtain Electronic Communications via Laundry, Distribution and Food Service Joint Board, Workers United/SEIU (LDFS JB). You acknowledge that withdrawing your election to receive and/or obtain Electronic Communications will slow the speed by which you receive communications from Laundry, Distribution and Food Service Joint Board, Workers United/SEIU (LDFS JB). If you wish to withdraw your consent, uncheck the “I AGREE” checkbox at the bottom of this document.

5. Valid and Current Email Address, Notification and Updates. Your current valid email address is required in order for you to obtain Electronic Communications. You agree to keep Laundry, Distribution and Food Service Joint Board, Workers United/SEIU (LDFS JB) informed of any changes in your email address. To modify your email address, contact us at (973)735-6464 or via the Laundry, Distribution and Food Service Joint Board, Workers United/SEIU (LDFS JB) Member Portal at http://ldfsunion.org/.

Laundry, Distribution and Food Service Joint Board, Workers United/SEIU (LDFS JB) may notify you through email when an Electronic Communication or updated agreement pertaining to Laundry, Distribution and Food Service Joint Board, Workers United/SEIU (LDFS JB) and your account information is available. Laundry, Distribution and Food Service Joint Board, Workers United/SEIU (LDFS JB) prefers to provide all of the required notices and disclosures to you by the same method and to the same address you have provided. Thus, you can receive all notices and communication as Electronic Communications or in paper format subject to the potential consequences of receiving paper versions of Electronic Communications as described in Paragraph 4.

6. Minimum Technology Requirements. You are responsible for installation, maintenance and operation of your computer, browser and software. Laundry, Distribution and Food Service Joint Board, Workers United/SEIU (LDFS JB) is not responsible for errors or failures from any malfunction of your computer, browser or software. The following are the minimum technology requirements necessary to receive Electronic Communications:

Operating Systems:	Windows® 2000, Windows® XP, Windows Vista®, Mac OS® X
Browsers:	Final release versions of Internet Explorer® 7.0 or above (Windows only); Mozilla Firefox 3.0 or above (Windows and Mac); Safari™ 6.0 or above (Mac only)
PDF Reader:	Acrobat® or similar software may be required to view and print PDF files
Screen Resolution:	800 x 600 minimum

** These minimum requirements are subject to change. If these requirements change, you will be asked to re-accept the disclosure. Pre-release (e.g. beta) versions of operating systems and browsers are not supported.