Civilian WVTA L2019 ACTIVE Membership Dues - CC/Debit

WEST VIRGINIA TROOPERS ASSOCIATION

Application for membership
Dues help support the negotiation of contracts, protection of workers' rights, resolution of workplace issues, and the organization of advocacy efforts.

Membership dues also fund legal representation, contract enforcement, union meetings, training initiaves, and the general operation of the local office.

The West Virginia Troopers Association (WVTA) is affiliated with the Communications Workers of America (CWA), a national union representing 700,000 members in both public and private sectors through more than 1,200 chartered local unions.
Personal Information
Full Name*

First NameMiddle NameLast NameSuffix
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Date of Birth*

MonthDayYear
Personal Email Address*
example@example.com
Personal Cell Phone*
Please enter a valid phone number.
Employment Information
Employer*

State of West Virginia
Hire Date*

MonthDayYear
Date
West Virginia County*
Title*
Troop number
Work Location (address)*

Street Address

Street Address Line 2

CityState

Zip Code
Beneficiary for Life Insurance

Boston Mutual Life Insurance-Please call the WVTA office w/personal information needed once you are a member. (304)345-9882
Name of the Beneficiary*

First NameLast Name
Relationship*
Beneficiary Date of Birth*

MonthDayYear
Beneficiary Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
Beneficiary Cell Phone*
Please enter a valid phone number.
Recurring Bi-weekly Union Dues Deduction
With the West Virginia Troopers Association, dues are used for bargaining contracts, defending our worker rights, solving issues in the workplace, and organizing campaigns. We represent members in disputes and negotiate contracts, legal fees to defend our contracts, union meetings, training programs, and maintaining the local office.

Once I am accepted as a new member or I enter my dues payment method as an existing member, I authorize the West Virginia Troopers Association to charge me union dues totaling $10.46 bi-weekly.

If you want your membership dues to be deducted on a payday, make sure that you signup on a payday.

For example, if you sign up on February 11th, your first dues will be deducted on that same day and your next dues payment will be automatically deducted on February 25th and so on.

Membership dues payment method*

CIVILIAN ACTIVE MEMBER - Bi-weekly membership dues

$10.46 for each two weeks

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Employee E-Signature*

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WEST VIRGINIA TROOPERS ASSOCIATION

Personal Information

Employment Information

Beneficiary for Life Insurance

Recurring Bi-weekly Union Dues Deduction