Membership Form Please enable JavaScript in your browser to complete this form.Layout Fairfax Workers Coalition Authorization for Deduction of Dues Active County EmployeesThe Fairfax Workers’ Coalition (FWC) is an independent voice for all Fairfax County employees, not affiliated or controlled by any outside organization. Its purpose is to give Fairfax County workers a true voice in a group that is transparent, open to all, truly run by its members and democratic in every aspect of its operations. All financial statements will be open and decisions will be made by the membership. We need an independent voice that truly represents the needs of Fairfax employees.Please join us today in this effort to bring democracy back to Fairfax County workers’ representation.Apply for Membership *I, the undersigned, hereby apply for membership in the Fairfax Workers’ Coalition (FWC) as my duly authorized representative on matters relating to my workplace issues, pay, benefits, retirement and health care. Please consider this your authority to abide by the Constitution and By Laws of FWC.Authorize my Employer *I hereby authorize my employer, the Fairfax County government, to deduct from my earnings the current dues of $10 per pay period, only subject to change by an open membership vote in accordance with FWC’s Constitution and By Laws.NAME OF EMPLOYEE *FirstLastCOUNTY AGENCY & FOCUS I.D. # or last 4 of SSN *MAILING ADDRESSAddress Line 1City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeLayoutEMAIL ADDRESS (non-County) *SIGNATURE OF EMPLOYEE *Clear SignatureHOME PHONE NO.DATE *MOBILE PHONE NO. *PRINTED NAME *WELCOME TO YOUR INDEPENDENT VOICE FOR FAIRFAX COUNTY WORKERS! FOR USE BY FFXWC OFFICIAL Please return your membership form via email to fairfaxworkerscoalition@outlook.com or take photo of form and text to 703-401-3131 I hereby certify that the regular dues of this organization for the above named member are currently established at $10.00 biweekly.LayoutSIGNATURE AND TITLE OF AUTHORIZED UNION OFFICIALDATEName of referring member (if applicable)Submit
