District1199NM

National Union of Hospital and Health Care Employees, District 1199NM
AFSCME, AFL-CIO 130 Alvarado NE Suite 100, Albuquerque NM 87108-1602
Application For Membership

First Name: *

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Last Name:*

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Apt:

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Employed At: *

Dept.: *

Title: *

Hourly Salary $: *

Hours Per Week: *

Date Hired: *

Shift: *

Cell Phone: *

Home Phone: *

Personal Email: *

ID #:

Date:
06/08/2023

I hereby accept membership in the National Union of Hospital and Health Care Employees, AFSCME, AFL-CIO, and designate said Union to act for me as collective bargaining agent in all matters pertaining to conditions of employment. I hereby pledge to abide by the Constitution and By-Laws of District 1199NM, the National Union of Hospital and Health Care Employees, AFSCME, AFL-CIO.

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