YES! I want to become a member of SEIU Healthcare Minnesota!

I authorize SEIU Healthcare Minnesota to represent me for the purpose of collective bargaining with my current employer and any future health care employers in Minnesota and to negotiate and conclude all agreements respecting wages, hours, and other conditions of employment. I request to be a member of SEIU Healthcare Minnesota while I am employed by my current employer and while I am employed by any future employers that have contracts or bargain collectively with SEIU Healthcare Minnesota.


By providing my phone number, I understand that SEIU and its locals and affiliates may use automated calling technologies and/or text message me on my cellular phone on a periodic basis. SEIU will never charge for text message alerts. Carrier message and data rates may apply to such alerts. Text STOP to 787753 to stop receiving messages. Text HELP to 787753 for more information.

I recognize the need for a strong union and believe everyone represented by our union should pay their fair share to support our union’s activities. I hereby request and voluntarily authorize my employer or their agent to deduct from my earnings and to pay over to SEIU Healthcare Minnesota each and every month or pay period an amount equal to the regular monthly or periodic dues uniformly applicable to members of SEIU Healthcare Minnesota.

This authorization shall remain in effect and shall be irrevocable unless I revoke it by sending written notice via U.S. Mail to SEIU Healthcare Minnesota during the period not less than thirty (30) days and not more than forty-five (45) days before the annual anniversary date of this agreement or the date of termination of the applicable contract between the employer and SEIU Healthcare Minnesota, whichever occurs sooner. This authorization shall be automatically renewed as an irrevocable check-off from year to year unless I revoke it in writing during the above-described window period, even if I have resigned my membership in SEIU Healthcare Minnesota. All terms of this dues check-off authorization, including the window period for revocation, shall apply while I am employed by my current employer and while I am employed by any future employers that have contracts or bargain collectively with SEIU Healthcare Minnesota.

Contributions or gifts to SEIU Healthcare Minnesota are not deductible as charitable contributions for Federal income tax purposes, but they may be tax deductible under other provisions of the Internal Revenue Code.

The invalidity or unenforceability of any particular provision hereof shall not affect the other provisions, and this Agreement shall be construed in all respects as if such invalid or unenforceable provision were omitted. By submitting this form, it shows that I agree with the terms above.