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Application for Membership

Authorization for Deduction

I, the undersigned, hereby join the New Mexico Public Employee Retiree Chapter 18, AFSCME and designate said chapter as my duly chosen and authorized representative to promote and protect my economic welfare to the extent authorized by law. I hereby request and authorize the deduction from my PERA pension payment the amount certified by the Retiree Chapter as the current rate of dues. I understand that I am liable for payment of AFSCME dues if my pension payment is not sufficient to cover the cost of annual membership.

First Name *

Middle Initial

Last Name *

Address *

Address 1 *

Address 2

City *

State *

ZIP code *

Social Security Number (only the last four digits) * Required by PERA to process.

Personal Email Address *

Home Phone

Cell Phone † † By providing your cell phone number you consent to receive calls (including recorded or autodialed calls, or texts) at that number from AFSCME and its affiliated labor, political and charitable organizations on any subject matter. Your carrier’s rates may apply. You may modify your preferences at: https://www.afscme.org/tcpa.

Signature

Effective Date

Month

Day

Year

AFSCME Council 18: New Mexico and Colorado

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