MAGE MEMBERSHIP APPLICATION

Print out this form complete, and mail to the MAGE office at: 

MAGE -6920 S Cedar Suite 4 -Lansing MI 48911-6924 

OR Fax to:  517-694-8250

Last Name:_____________________________First Name_____________________________Middle:_____

Address:________________________________________City, State, ZIP____________________________

Phone Numbers Home (        )                              Work(       )                                      

Residence County________________     Home Email:___________________________

Department_______________________ Agency or Facility ________________________________

Civil Service Classification & Level ___________________________________________  

EMPLOYEE ID NUMBER:  ____________________________ DUES CODE - ESO1

If you have a preference please select a District below, if no preference is listed your membership will be listed as a member within the geographical District you reside in.   MAGE District #________  (click here to see your geographical  District)

Please select a membership type below.  Only cash  membership applications must be accompanied by a check or money order equal to $109.44, make checks  payable to MAGE to begin a membership. This amount is equal to 6 pay periods.  Your next bill will be pro-rated through the end of the quarter/ billing period.  

 Payroll deduction type membership must fill out authorization for payroll dues deduction below:

Membership Type (select one):     Payroll Deduction_____      OR    Cash Payment_____   

Authorization for Payroll Dues Deduction for Michigan Association of Governmental Employees:

On this day___________in the year of ___________I, the undersigned State Employee do hereby authorize the State of Michigan to deduct the sum of $18.24 from any earned accrued wages due me each biweekly period until revoked by written notice and to remit said amount to the Michigan Association of Governmental Employees as payment of my association dues. Further, I hereby authorize MAGE OPEIU Local 2002 to act as my exclusive representative should collective bargaining rights be granted to Managerial, Supervisory and Confidential Employees.   In addition, my consent is hereby given to increase this amount to any amount that is determined by the members of the Michigan Association of Governmental Employees in accordance with their bylaws.

Name (Please Print)________________________________________Signature___________________________________________________