Membership Application & Dues Authorization

	Membership Application Association of Scientists and Professional Engineering Personnel
Name `______________________________________________________________` First Middle Name or Initial Last Address `___________________________________________________________` Street City State & Zip Code
Home Phone`_____` Co. Phone `_______` Degree(s) `_______`	Date of Birth`____________________` Co. Mail Stop `___________________` School(s) `_________________________________________`
Soc. Sec. No.`__ __ __ - __ __ - __ __ __ __` I hereby designate the Association of Scientists and Professional Engineering Personnel (ASPEP) to act as my exclusive representative for the purpose of collective bargaining with my employer in all matters pertaining to wages, hours, and working conditions, and other terms and conditions of employment.
Date`___________` New Member's Council Group # `___`	Signature`____________________________________________` Recommended by:`_______________________________________`

Dues Deduction Authorization
I, the undersigned, do hereby direct my employer to deduct from my pay each week a sum equivalent to my weekly membership dues, and remit same promptly to the Treasurer of the Association of Scientists and Professional Engineering Personnel. This authorization shall become effective immediately, and shall remain in effect until revoked by me in a written notice to both parties.
Date`________________`	Signature`_______________________________`
Section # `_________` (or Activity or Center)	Employee No.`_______________________`

Revised: 8/98 OnLine Version 30 Nov. 99 (wlm)