UAW 2750 Membership and E-Dues Authorization Form

UAW 2750 Membership and E-Dues Authorization Form
Join your union! Your membership makes our union stronger, which is the key to winning improvements at NIH and beyond.

Membership means the right to participate in the union. Membership builds our collective power to win more pay, rights, and benefits at NIH. Learn more about membership here.

To ensure a smooth submission of your membership, we recommend using non-NIH wifi to complete this form.
First Name*
Last Name*
Preferred Name
NIH Email*
example@nih.gov
non-NIH Email*
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Institute/Center*
NIH Badge Number*
Stipends Amount (Annual or Monthly)*
PI/Supervisor*
Office - Building
Office - Room
Home Address - Street Address Line 1*
Street Address Line 2
City*
State/Province*
Postal/Zip Code*
Postbaccalaureate FellowPredoctoral FellowPostdoctoral FellowVisiting FellowResearch FellowClinical FellowOther
I authorize the Union to deduct monthly membership dues consistent with the UAW Constitution (currently 1.1% of my gross monthly pay). Unless revoked, this authorization is to remain in effect any time I am a UAW member and working in a position represented by UAW 2750. I recognize that my authorization of dues deductions and the continuation of such authorization is voluntary and not a condition of my employment.

I understand that after submitting this form I will receive a follow up email including instructions for setting up recurring, direct dues payments to UAW Local 2750 and that my membership is not in good standing until these payments are authorized.

I understand that this authorization will become effective on the first of the month following its receipt. Contributions or gifts (including dues) to the labor organization are not tax deductible as charitable contributions. However, they may be tax deductible under other provisions of the Internal Revenue Code.
Signature*

Clear
Date*

MonthDayYear
Date
The information requested in this form will be used solely by UAW 2750 to set up and manage your union dues payments. Providing the requested information is voluntary; however, declining to provide the necessary information will prevent us from setting up your recurring dues payments and maintaining your membership in good standing.

Your information will be kept confidential and used only for union membership and dues administration purposes. We will not share your personal or financial information with third parties without your consent, except as required to process dues payments through our payment processor.

This form should take approximately 5 minutes to complete. If you have any questions or concerns about this form or how your information will be used, please contact us at info@nihfellowsunited.org.
Your Membership Form is not yet complete! Please click below to continue on to the required Dues Deduction Authorization section. Your membership will not be processed until the entire form is completed and submitted.
FTE Fellows are required by law to fill out the following additional form to authorize dues deduction.

The NIH uses Badge Number as Employee Identification numbers. Please do not put your Social Security number anywhere on form 1187.
Postbaccalaureate FellowPredoctoral FellowPostdoctoral FellowVisiting FellowResearch FellowClinical FellowOther
Non-FTE Fellows are required by law to fill out the following additional form to authorize dues deduction.
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Work Location - Building
Work Location - Room
Cell Phone
Please enter a valid phone number.Format: (000) 000-0000.
Institute or Center
Supervisor
I accept membership in the UAW and its designated Local that represents me with respect to my working conditions at NIH. I agree to pay monthly dues, currently 1.1% of my gross pay. I authorize NIH to deduct the monthly membership dues from my pay and remit them to the Union. Unless revoked, this authorization is to remain in effect for all periods of time in which I am a UAW member and receiving a paycheck for work performed in a UAW-represented unit.
Should be Empty:

UAW 2750 Membership and E-Dues Authorization Form

FTE Fellows are required by law to fill out the following additional form to authorize dues deduction.

Non-FTE Fellows are required by law to fill out the following additional form to authorize dues deduction.