Membership Application

Name:______________________________________________

Organization Code:____________________________________

Street Address:______________________________________

City:_______________________________________________

State:______________________________________________

Zip:________________________________________________

Phone (Home):______________________________________

Phone (Work):______________________________________

Fill out NASA Standard Form 1187, "Request For Payroll Deductions For Labor Organization Dues" ($ 6 per pay period) available at: http://www.opm.gov/forms/html/sf.htm ) OR Make Check Payable to MESA for Annual or Semi-Annual Dues ($ 156 annual, $ 78 semi-annual)

Enclose Check or NASA Form 1187 with this Membership Application and send to one of the following:

Applicant's Signature________________________  Date______

Approved_________________________________  Date___________

PRIVACY POLICY

PRIVACY NOTICE FOR THE MEMBERSHIP APPLICATION

The MESA (IFPTE Local 27) has created this privacy notice to explain how we will use the information collected in this form. MESA may change this policy from time to time so we encourage you to check this page when revisiting this website.

The MESA (IFPTE Local 27) uses this information internally to contact members concerning MESA business. For example, problems with dues payment or to consult with an employee on the duties privileges and responsibilities of serving in a leadership role.

The MESA (IFPTE Local 27) does NOT share our membership list with any NASA employee or representative OTHER THAN those who serve as officers of MESA

The MESA (IFPTE Local 27) DOES share the membership list, including names and mailing addresses, with our parent organization IFPTE.

The MESA updates the membership list annually in October, and does not retain the information for individuals who are no longer members.

NOTE:   The MESA does NOT ask for a social security number, and we frown on NASA MSFC's use of social security numbers as personal identifiers, we also do NOT ask for a birthdates, a driver's license number, a credit card number or any other unique personal identifier. Please do not provide this information to us!

The IFPTE will use this information in the following ways:

1. To verify membership for the payment of dues FROM MESA (Local 27) to IFPTE.
2. To send the quarterly news publication IFPTE Outlook (free) to members.
3. To verify membership status of an employee who has applied for additional Union benefits or services such as scholarships or insurance (See IFPTE Benefits for more information).