Pacific Northwest Newspaper Guild
Secure Signature Portal
Cascade PBS
Thank you for agreeing to pay dues via direct deposit. Your contribution to the Pacific Northwest Newspaper Guild keeps our union strong as we fight to protect journalists across the region. Dues are 1.5% of your base rate of pay. To calculate your monthly dues, please complete the following calculation:
Annual pay / 12 = Monthly pay
Monthly pay * .015 = Monthly dues
Dues do not apply to holiday pay, overtime or other earnings made outside of your base rate of Pay.
I hereby authorize The Pacific Northwest Newspaper Guild, Local 37082, hereinafter called the Guild, to initiate debit entries to my checking/savings account indicated below and the depository named below, hereinafter called depository, to debit same to such account.
This authority is to remain in full force and effect until the Guild and Depository has received written notification from me of its termination in such time and in such manner as to afford the Guild and Depository a reasonable opportunity to act on it.
Name
(Required)
First
Last
Date of Birth
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Month
Day
Year
Phone
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Gender
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Female
Male
Transgender
Non-binary/non-conforming
Prefer not to respond
Home Address
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Street Address
City
State / Province / Region
ZIP / Postal Code
Employer
(Required)
Date of Hire
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Month
Day
Year
Work Phone
(Required)
Department in Which Employed
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Job Title
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ACH Details
Dues Payment Amount
(Required)
Dues are 1.5% of your base rate of pay. To calculate your monthly dues, please complete the following calculation:
Annual pay / 12 = Monthly pay
Monthly pay * .015 = Monthly dues
Name of Bank
(Required)
Bank Street Address:
(Required)
Account Number
(Required)
Routing Number
(Required)
Debited On
(Required)
The 1st of the month
The 15th of the month
The 1st and 15th of the month
Membership Agreement
Designation Agreement
(Required)
I designate Pacific Northwest Newspaper Guild, Local 37082 as my collective bargaining representative, and to represent me before any Board, Court, Committee or other tribunal in any matter involving collective bargaining. I authorize Pacific Northwest Newspaper Guild, Local 37082 to represent me in adjusting any grievances I may have in connection with my employment.
Authorization
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I have read and agree to the terms and conditions, confirm the accuracy of the information provided, and consent to the processing of my data for the purpose stated. By checking this box, I acknowledge that I am the person completing and signing this form.
Signature
Signature
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Today's Date
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Comments
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