UNITED HOME CARE WORKERS OF PENNSYLVANIA

Join the movement.

I hereby apply for membership in the United Home Care Workers of Pennsylvania (UHWP), a joint partnership of SEIU and AFSCME. I understand that membership in UHWP is voluntary and that I may cancel my membership at any time by contacting UHWP.

Membership Dues Deduction Authorization*

*I also hereby authorize my employer and/or payroll processing agent performing fiscal management services to deduct from my wages my voluntary membership dues as shall be certified by UHWP and to remit all deductions to UHWP. This authorization is unconditional and is made irrespective of my membership in the Union. To revoke this authorization, understand must send written request, with my original signature, to UHWP at 1500 N. 2nd Street, Harrisburg. PA 17102. Contributions to UHWP are not tax deductible as charitable contributions. However, they may be tax deductible as ordinary and necessary business expenses.

In the event payroll deduction from my employer and/or the payroll processing agent performing fiscal management services for my employer is not available, I authorize UHWP to make withdrawals from my checking or savings account, in accordance with the authorization provided below or to another account I provide and authorize separately. I am authorized to make decisions about the account provided to the UHWP. UHWP will notify me of the transition to direct pay at the current mailing address on file with UHWP prior to initiating the first payment via debit card, credit card, checking, or savings account, as authorized below.

I hereby authorize UHWP to initiate a recurring, automatic electronic funds transfer each pay cycle with my financial institution beginning on the date listed in the transition notice provided to me in order to deduct from the account listed below (or separately provided) an amount equal to 1.5% of my gross earnings with a maximum of twenty dollars per pay.

The voluntary membership dues amount may change if authorized according to the requirements of UHWP official processes. If this happens, I authorize UHWP to initiate a recurring, automatic electronic funds transfer each pay cycle in the amount of the new membership dues amount when notified by UHWP in writing of the new amount and with at least ten (10) days' notice before the next funds transfer date. In the case of checking and savings accounts, adjusting entries to correct errors are also authorized. I agree that these withdrawals and adjustments may be made electronically and under the Rules of the National Automated Clearing House Association. This authorization shall remain in effect until I revoke my authorization in writing and deliver it to UHWP at 1500 N. 2nd Street, Harrisburg, PA 17101 or info@pahomecareworkers.org. I acknowledge that failure to pay my voluntary membership dues on a timely basis may affect my membership standing in UHWP.

Contributions to UHWP are not tax deductible as charitable contributions. However, they may be tax deductible as ordinary and necessary business expenses.

Yes! want to hold elected officials accountable to working families.

am volunteering to contribute to the United Home Care Workers of Pennsylvania Accountability Fund supporting the SEIU Committee on Political Education (COPE) and PEOPLE, the AFSCME Political Action Committee, to help ensure policymakers stand up for home care workers and consumers. hereby authorize my employer and/or any payroll processing agent performing fiscal management services for my employer to deduct the indicated amount from my paycheck each pay and forward the amount specified to the United Home Care Workers of Pennsylvania Accountability Fund to be distributed equally to SEIU COPE and AFSCME

This authorization is made voluntarily based on my specific understanding that: 1) am not required to sign this form or make voluntary political contributions, partof which is remitted to SEIU COPE and part to AFSCME PEOPLE, as a condition of my employment or membership in UHWP:2) 1 may refuse to contribute without reprisal; 3) Under law, only members who are U.S. Citizens or lawful permanent residents are eligible to contribute to SEIU COPE and AFSCME PEOPLE; 4) The contribution amounts on this form are merely suggestions, and may contribute more or less by this or other means and that UHWP cannot favor or disadvantage me because of the amount of my contribution or my decision not to contribute; 5) SEIU COPE and AFSCME PEOPLE use the money they receive for political purposes including. but not 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 contribution is in addition to voluntary membership dues and existing contributions through payroll deduction/DPA transfer. This authorization shall remain in effect until revoked by me in writing via U.S. mail to the UHWP.Contributions or gifts to SEIU COPE and AFSCME PEOPLE are not tax deductible as charitable contributions.