AUTHORIZATION FOR DUES DEDUCTION THE STATE OF OHIO, UNIT 2 ASSOCIATION-Unit 2 Association

AUTHORIZATION FOR DUES DEDUCTION THE STATE OF OHIO, UNIT 2 ASSOCIATION

c/o Lazarus & Lewis, LLC

30 Garfield Place, Suite 915

Cincinnati, Ohio 45202-4322

(513) 721-7300

I, the undersigned, hereby authorize my Employer to check off and deduct from my payroll an amount equal to dues, remitting directly to Lazarus & Lewis, LLC

Place of Employment

First Name

Last Name

Home Address

Personal Phone Number

Classification

Personal Email. DO NOT ENTER STATE EMAIL

Your Signature

Select Today's Date

Powered by