MEMBERSHIP FORM - TEAMSTERS QUEBEC LOCAL 106 - Category 1: Nursing and Cardio-Respiratory Personnel

I hereby apply for membership of TEAMSTERS QUEBEC LOCAL 106 (Affiliated to the International Brotherhood of Teamsters) and authorize its representatives to represent me in negotiating a Collective labour Agreement with my employer. Category 1: Nursing and Cardio-Respiratory Personnel -Licensed Practical Nurse (LPN)

Is there another union currently in place that you are going to resign from? Yes No

The present resignation becomes effective when notified or signified to the said association. Furthermore, the present constitutes notice to my employer to stop deducting my union dues to be remitted to the said association, however, I do authorize my employer to deduct the same union dues in order to remit them to: TEAMSTERS QUEBEC LOCAL 106 or to invest in a trust company until final settlement.

I resign from the union (name of the union in place) *

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Keep the same address for your online payment Yes

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MEMBERSHIP FORM - TEAMSTERS QUEBEC LOCAL 106 - Category 1: Nursing and Cardio-Respiratory Personnel