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                     GOVERNMENTAL EMPLOYEES LABOR COUNCIL

                                 667 E. Big Beaver, Suite 205, Troy, Ml 48083

                              Membership Application and Dues Check-off Card

I hereby agree to become a member of the Governmental Employees Labor Council (GELC), with all corresponding rights and responsibilities as laid out in the GELC Constitution and By-Laws.   I understand that I may resign my membership in the GELC at any time by providing to GELC's Director a written notice of my resignation.  Such resignation will be effective immediately upon receipt by GELC of my written notification.

Furthermore, I hereby voluntarily request and authorize to be deducted from my wages earned while in your employ, a labor representation fee per month.  I further authorize any increase in this deduction which is approved by the GELC or the local bargaining unit.  If any additional deductions are to be made, it must be approved by the office of the GELC. The amount deducted for the labor fee shall be remitted on or before the 10th of each month to the Governmental Employees Labor Council, 667 E. Big Beaver, Suite 205, Troy, Ml 48083.

This authorization, assignment, and direction is voluntary and not conditioned on present or future membership in the Union, and shall be irrevocable for the term of the applicable contract between the Union and the Employer or for one year, whichever is the lesser, and shall automatically renew itself for successive yearly or applicable contract periods thereafter, whichever is the lesser, unless the employee gives written notice to the Employer and the Union at least sixty (60) days, but not more than ninety (90) days before any periodic renewal date of this authorization and assignment of the employee's desire to revoke same.

Labor Representation Fee $ *
Labor Representation monthly fee
First Name *
Middle Initial
Last Name *
Home Address *
City *
State *
Postal Code *
Email *
Cell Phone *
Home Phone
Employer *
Its Successors and Assigns
Job Title / Classification *
Authorize Agreement *
BY SIGNING THIS DOCUMENT ELECTRONICALLY, I CONSENT TO ENTER INTO THIS AGREEMENT FOR AUTHORIZATION OF DUES DEDUCTION WITH THE GOVERNMENTAL EMPLOYEES LABOR UNION (GELC). I HAVE READ, UNDERSTAND, AND SUBMIT THIS APPLICATION TO BE ADMITTED AS A MEMBER OF THE GELC.
Signature *

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Police Officers Labor Council
667 E Big Beaver Rd Suite 205
Troy, MI 48083
  248.524.3200

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