District 1199NM

DISTRICT 1199NM, National Union of Hospital and Health Care Employees, AFSCME, AFL-CIO
6201 Uptown Blvd NE Suite 201, Albuquerque, NM 87110-4192
505.884.7713 - www.nmhospitalworkersunion.com

UNION MEMBERSHIP APPLICATION AND DUES AUTHORIZATION

Full Name: *

Date:
09/17/2024

Address: *

Apt:

City: *

State: *

Zip: *

Home Phone: *

Cell Phone: *

Personal Email: *

Employed At: *

Dept.: *

Title: *

Emp ID #:

Shift: *

Date Hired: *

Salary $: *

Hours Per Week: *

I hereby accept membership in the National Union of Hospital and Health Care Employees, AFSCME, AFL-CIO, and designate the Union to act for me as collective bargaining agent in all matters pertaining to conditions of employment. This authorization is made pursuant to the provisions of the law including 302(c) of the Labor Management Relations Act of 1947.

I hereby pledge to abide by the Constitution and By-Laws of District 1199NM, the National Union of Hospital and Health Care Employees, AFSMCE â€“ AFL-CIO.

To Employer: The hospital is directed to deduct from wages earned by me such amount as may be established by the National Union of Hospital and Health Care Employees, AFSCME, AFL-CIO and become due as my membership dues and/or fees or assessments in the Union, I hereby authorize the hospital to deduct such amount from one or more of my paychecks each month as required and to remit the same to the Secretary Treasurer of said Union. The authorization of dues is effective upon receipt of this union card, subject to the provisions of the union contract.

Cancellation of dues is specified in each union contract.

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