PROTEC17 - APPLICATION FOR MEMBERSHIP

JOIN PROTEC17 MEMBERSHIP FORM

Name*
First Last
Work Email
Home Email*
Cell Phone*
Employer*
Department/Bureau*
Job Title/Classification*
*By providing my personal phone and email information, I understand that PROTEC17 may contact me by email, text or phone on a periodic basis and that I may unsubscribe at any time.
I want to be a PROTEC17 member!
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Yes, I recognize the need for a strong union in my workplace and want to join with my co-workers and become a member of Professional and Technical Employees Local 17 (PROTEC17). I designate PROTEC17 as my exclusive bargaining representative for the purposes of collective bargaining with respect to wages, hours and other conditions of employment. I understand that my signature may be used to obtain certification of PROTEC17 as the exclusive bargaining representative, without an election.
Signature*
Date Signed*
MM slash DD slash YYYY
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Yes, I recognize the need for a strong union and believe everyone represented by our union should support our union’s activities. In exchange for PROTEC17’s commitment to advocate for me, my coworkers, and my community, for member-only benefits provided through the PROTEC17 Member Advantage Program, and for other good and valuable consideration, I hereby request and voluntarily authorize my employer to deduct from my earnings and to pay over to PROTEC17 an amount equal to the regular monthly dues set by PROTEC17’s Constitution and Policies (currently equal to 0.85% of my monthly salary). I direct that this authorization will remain in effect and be irrevocable unless I revoke it in writing sent via U.S. mail 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. I recognize that this authorization is voluntary and not a condition of employment and shall be automatically renewed from year to year unless I revoke it in writing during the window period, irrespective of my membership in PROTEC17.
Signature*
Date Signed*
MM slash DD slash YYYY
I want to support the Political Action Committee!
I am least 18 years old. I am a U.S. citizen or lawfully permitted resident (i.e., green card holder) I am making these contributions from my own funds, and funds are not being provided by another person or entity for the purpose of making these contributions. I am not a foreign national nor are these contributions financed in any part by a foreign national, and no foreign national was involved in making decisions regarding these contributions in any way. I am not a federal contractor I am not a registered Federal lobbyist I am not a registered foreign agent.
Yes, I recognize the need to contribute to political candidates in Washington state who support working families and their issues. I understand that I am voluntarily contributing to the separate PROTEC17 Political Action Committee (PAC) fund and that my union dues money never goes to the endorsement of political candidates. I understand that my contributions to the PAC are not deductible for federal income tax purposes. I also certify that the following statements are true and agree to these contribution rules. This certification shall apply to each contribution I make and remain in effect until revoked in writing via U.S. mail to PROTEC17.
I am least 18 years old.

I am a U.S. citizen or lawfully permitted resident (i.e., green card holder)

I am making these contributions from my own funds, and funds are not being provided by another person or entity for the purpose of making these contributions.

I am not a foreign national nor are these contributions financed in any part by a foreign national, and no foreign national was involved in making decisions regarding these contributions in any way.

I am not a federal contractor

I am not a registered Federal lobbyist

I am not a registered foreign agent.

Signature

Date Signed

PAC Donation Amount

Signature

Date Signed

No employer or labor organization may discriminate against an officer or employee in the terms or conditions of employment for (a) the failure to contribute to, (b) the failure in any way to support or oppose, or (c) in any way supporting or opposing a candidate, ballot proposition, political party, or political committee you for contributing or not contributing to a political committee, or supporting or opposing a candidate, ballot measure or political party.

JOIN PROTEC17 MEMBERSHIP FORM

I want to be a PROTEC17 member!

I want to support the Political Action Committee!