I am opposed to all unions.  Therefore, I am opposed to ALL benefits that unions have won through the years; 40-hour work-week, time-and-a-half for overtime, double-time on holidays, weekends, sick leave, child labor restrictions, wage increases, workplace safety standards, pensions, employer-paid insurance plans, unemployment benefits, job security, and legal representation for wrongful termination.

I hereby refuse to accept any benefits that have been or ever will be won by unions and also hereby authorize and direct the Company to withhold the amount of Union-won benefits from my paycheck.

Signed__________________________________                                                              Date_________________________