NUHW membership application/Dues and COPE authorization for Kindred Santa Cruz

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    I hereby request and accept membership in National Union of Healthcare Workers, and authorize National Union of Healthcare Workers as my union and exclusive representative with my Employer(s) concerning wages, hours, and other terms and conditions of employment. I agree to abide by the Constitution and Bylaws and all amendments thereto, and by any contracts that may be in existence at the time of this application or that may be negotiated by the Union. I nearby authorize my employer to deduct from my wages and pay to National Union of Healthcare Workers the designated monthly dues necessary to secure and maintain Union membership as required by the Constitution and Bylaws of the Union and any applicable contracts. I understand that my Union dues rate will periodically increase or otherwise change in accordance with the Union's Constitution and Bylaws.

    I want to help build political power for healthcare workers by helping win on issues and elect candidates who are supportive of healthcare and workers' rights. I will make a voluntary monthly contribution to NUHW's Committee on Political Education (COPE):
    I understand this deduction is not tax-deductible and that this contribution is strictly voluntary and will be used for political purposes. The signing of this authorization form and the making of these voluntary contributions are not conditions of membership in NUHW nor my employment. My Union will not favor or disadvantage anyone by reason of the amount of their contribution or decision not to contribute. I may refuse to contribute without reprisal. My payroll deduction will continue until I notify NUHW in writing of any change. The submission of a new deduction authorization form will supersede any previous authorizations for this payroll deduction. I have the right to terminate this deduction at any time by providing written notification (or email) to NUHW. Federal campaign law requires political committees to report the following information for individuals whose contributions are more than $200 per year: name, address, occupation, and employer. All information will be kept confidential unless disclosure is required by law. You must be a member of NUHW or on its administrative/executive staff to make a contribution. You must be U.S. citizen or a person lawfully admitted for permanent residency in the United States in order to contribute. Contributions to NUHW may not exceed $5,000 per calendar year per contributor.