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United Mine Workers of AmericaOffice Use OnlyCheckoff Authorization Form Surviving Spouse Associate MembershipNew Surviving Spouse Associate Member Information Name:___Address:______City: ___State:
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Obtain a copy of the associate member checkoff authorization form.
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Fill in your personal information such as name, address, and contact details.
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Select the payment method you prefer for the checkoff authorization.
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Sign and date the form to indicate your agreement with the terms and conditions.
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Submit the completed form to the relevant authority for processing.

Who needs associate member checkoff authorization?

01
Associate members who wish to authorize deductions from their payment for membership fees or other purposes.
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Associate member checkoff authorization is a form that authorizes a member of an organization to have their membership dues automatically deducted from their bank account.
Any member of the organization who wishes to have their membership dues automatically deducted from their bank account is required to file associate member checkoff authorization.
To fill out associate member checkoff authorization, the member must provide their bank account information, sign the form, and submit it to the organization.
The purpose of associate member checkoff authorization is to simplify the payment process for members by automatically deducting their dues from their bank account.
The information required on associate member checkoff authorization includes the member's name, bank account number, routing number, and signature.
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