MEMBERSHIP AUTHORIZATION:*
I choose to become a member of the Pennsylvania Association of Staff Nurses and Allied Professionals and agree to remain a member in good standing by periodically tendering my dues, in the amount determined by the union, and by supporting the goals of the association to promote respect for our profession, decent working conditions, and effective patient advocacy.
I hereby authorize my employer to deduct the appropriate dues and assessments from my paycheck in accordance with the collective bargaining agreement. This authorization and assignment shall be irrevocable for a period of one (1) year, or until the termination of the agreement between the employer and the union, whichever occurs sooner; and I agree and direct that this authorization and assignment shall be automatically renewed, and shall be irrevocable for successive periods of one (1) year for the period of such succeeding applicable collective bargaining agreement between the employer and the union, whichever shall be shorter, unless such written notice is given by me to the employer and the union not more than forty-five (45) days and not less than thirty (30) days prior to the annual anniversary date of this authorization, or such applicable agreement between the employer and the union, whichever occurs sooner.
PAC AUTHORIZATION
By selecting a dollar amount below, I hereby authorize my employer to withhold the indicated amount per pay period to forward to PASNAP as a contribution to the PASNAP Political Action Committee (“PASNAP PAC”).
I make this authorization voluntarily with the understanding that:
1. I am not required to sign this form or make voluntary contributions to PASNAP PAC as a condition of my employment or membership in the union;
2. I may refuse to contribute without reprisal;
3. Under law, only union members and executive/administrative staff who are U.S. Citizens or lawful permanent residents are eligible to contribute to PAC;
4. The contribution amounts on this form are merely suggestions, and I may contribute more or less by this or other means without fear or favor or disadvantage from PASNAP or my employer;
5. PASNAP PAC uses the money it receives for political purposes - including, but limited to, making contributions to and expenditures on behalf of candidates for federal, state, and local offices - and addressing political issues of public importance.
This authorization shall remain in effect until revoked by me in writing to PASNAP.