Homecare Workers - Because We Care.
LOCAL 503
Membership Application
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SEIU Local 503, OPEU
Stronger Together
(Please print or type clearly.)
SOCIAL SECURITY NUMBER:
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BIRTH DA'
HOME E-MAIL:
PROVIDER #:
NAME:_________ '• -
____________ HOME PHONE:
RESIDENCE ADDRESSM e ^
^REQUIRED)
MAI LI NG ADDRESS:
YEAR
DAY
MONTH
.I_ ______________ _____
STREET
CITY
STATE
ZIP
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I desms to be represented by SEIU Local 503, OPEU and hereby designate SEIU Local 503, OPEU as my bargaining agent for all matters
pertaining to collective bargaining. I request my employer to deduct from my salary, wages, or other sums due me by virtue of my
employment, the amount of my dues for membership in SEIU Local 503, OPEU as provided in Jts Bylaws, and disburse same to SEIU
Local 503, OPEU, unless notified by me in accordance with any union security agreement in effect.
The SEIU Local 503, OPEU Bylaws (Art. XIV Sec. 9) provide for a contribution as determined from time to time by
the member-elected General Council for the benefit of the Union's political action program. You may opt to have this contribution go
to the SEIU Local 503, OPEU Scholarship Fund instead of the political action program by checking the box at the right. O
Voluntary SEIU Local 503, OPEU Political Action Check-off
Citizen Action for Political Education (CAPE)
$4.16/month
$8.33/month
This contribution qualifies for the Oregon Political Tax Credit. Single filers are eligible for a credit of up to $50 per
year: joint filers up to $100 per year. I hereby authorize my Employer to deduct the designated amount from my monthly
earnings as a contribution to SEIU Local 503, OPEU CAPE.
My contribution will be used to support member-endorsed
candidates and for expenditures in connection with elections for Local, Legislative, Statewide and Federal offices.
These elected officials make critical decisions on salaries, healthcare, retirement and other benefits and laws affecting SEIU
Local 503, OPEU members. A portion of this contribution (as much as 48% for the average contributor) may be used by SEIU
for federal elections. This contribution qualifies for the Oregon Political Tax Credit. Single filers are eligible for a credit of up to
$50 per year joint filers up to $100 per year. This contribution is not deductible for federal income tax purposes.
The contribution amounts indicated above are only suggestions and I may choose not to contribute or to vary my contribution
amount without reprisal from my Union or my Employer. As per federal law, only union members and union executive/administrative
staff who are U.S. citizens or lawful permanent residents are eligible to contribute to SEIU COPE (the Federal Committee on Political
Education.) This authorization is made voluntarily and is not a condition of my employment or membership in the union. This
authorization shall remain in effect until revoked in writing by me. (This contribution is in addition to union dues.)
Dues and fees to SEIU Local 503, OPEU are not deductible as charitable contributions for federal income tax purposes.
Dues paid to SEIU Local 503, OPEU may qualify as business expenses, and may not be deductible in limited circumstances
subject to various restrictions imposed by the Internal Revenue Code. Changes which may from time to time occur in
state and federal law will not alter these deduction requests, unless so indicated by me.
SIGNATURE:__________________ ___ __________________ DATE:__________________________