LOCC Fair Share Fee Form

This is the LOCC Fair Share Fee authorization form. If instead you want to stand with your co-workers and join as a member of LOCC, please fill out a LOCC membership form here. Otherwise, click next to begin the Fair Share Fee authorization form.

Notice of Rights

Please read the following Notice of Rights before proceeding:

Please check the box to continue.

Name and Contact Information

Brown University Information

Fair Share Fee Authorization

I hereby request and voluntarily authorize Brown University or its successors to deduct from my earnings and to pay over to the union or its successors my fair share fee. I understand that the amount of the fair share fee shall be determined by the union in accordance with applicable law. This authorization applies only while I am employed as a Community Coordinator. Pursuant to the terms of Article III, § F(2) of the collective bargaining agreement between the Brown University and the union, this authorization shall remain in effect unless I revoke it by notifying the university or university-designated office in writing. My signature below is provided voluntarily and I hereby acknowledge that I have been provided with notification of my rights prior to affixing my signature below.

Please check the box to agree to authorize Fair Share Fee deduction.

Please sign in the box above to authorize Fair Share Fee deduction.