Some employers may be concerned that an annual written authorization by each employee will create an unwieldy paperwork burden and substantial costs to account for a worker's decision to withhold funds. This need not be the case. The language below is offered as a simple and understandable example for documenting a worker's choice. Please note that the underlined text in bold is variable; changes will be necessary according to the individual name of the worker, which union he is in, the amount of his dues, and so on.


A labor organization may solicit and obtain funds from you for political, ideological, social, or charitable events or activities, lobbying for legislation, organizing employees of other employers, or other activities that are not collective bargaining, contract administration, or grievance processing on an automatic basis, including but not limited to a payroll deduction plan, only if you affirmatively consent in writing to the contribution at least once every calendar year.

Your dues or fees for membership in, or union representation from, the Acme Labor Union are four-hundred-twenty-five dollars and zero cents ($425.00) for the year beginning 01/01/98 and ending 12/31/98.

Eighty-five dollars and zero cents ($85.00, or 20%) of your dues or fees may be used for political, ideological, social, or charitable events or activities, lobbying for legislation, organizing employees of other employers, or other activities that are not collective bargaining, contract administration, or grievance procession only if you voluntarily consent below.

Under state and federal law, you do not have to pay this amount. This amount will be subtracted from the dues or fees you owe if you do not sign this form to have your dues or fees used for organizing employees of other employers, lobbying, or participating in political, social, charitable, or other ideological activities that are not related to collective bargaining, contract administration, or grievance processing.

I, John Doe, voluntarily authorize Acme Labor Union to use $85.00 (20%) of my dues or fees for political, ideological, social or charitable events or activities, lobbying for legislation, organizing employees of other employers, or other activities that are not collective bargaining, contract administration, or grievance processing.

_____________________________ ____________
Employee Signature Date

cc: Your Employer
      Your Union President