A. Join MAPE: We’re all in this together! (Both parts A and B must be filled out and signed.) * Denotes required item First name * Last name * Home street * Home city * Home state * AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Marianas IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Home zip code * Cell phone Text messages Text me, call me! (+ See terms below) Home phone Home email Work phone Work email * Agency / Dept. Name * Recruited by I hereby request and voluntarily accept membership with and authorize the Minnesota Association of Professional Employees (“MAPE”) to represent me for the purpose of collective bargaining with my employer regarding wages/salaries, hours and other conditions of employment. Sign below if you agree to the above terms of Section A * Draw It Type It Clear Print your name B. Dues deduction authorization. (Both parts A and B must be filled out and signed.) I hereby request and voluntarily authorize my employer to deduct from my earnings and to send to MAPE an amount equal to the regular dues uniformly applicable to members of MAPE. The amount shall be certified by MAPE and any changes in such amount shall also be so certified. This amount shall be deducted and sent to MAPE at least monthly. This authorization and assignment is voluntarily made in consideration for the cost of representation and collective bargaining by MAPE as my exclusive representative and is not contingent upon my present or future membership in MAPE or a condition of my employment. I understand and agree that my authorization of dues check-off shall remain in effect and shall be irrevocable unless I revoke it by sending written notice bearing my signature to both my employer and MAPE during the period of not more than forty-five (45) days and not less than thirty (30) days before the annual anniversary date of this authorization. This authorization shall be automatically renewed as an irrevocable check-off from year to year unless I send written notice of revocation bearing my signature during the above-described window period. The invalidity of any particular provision hereof shall not affect the other provisions, and this authorization shall be construed in all respects as if such invalid provision were omitted. Contributions or gifts to MAPE are not tax deductible as charitable contributions. However, they may be tax deductible as ordinary and necessary business expenses. Sign below if you agree to the above terms of Section B * Draw It Type It Clear Print your name C. Contribute to MAPE’s PAC (MAPE Political Action Committee) Team MAPE and its Political Action Committee raise and contribute money to candidates and campaigns supportive of MAPE’s represented employees and MAPE’s legislative priorities. By making a PAC contribution you are helping to elect state officials supportive of public policies MAPE members care most about. I hereby authorize MAPE to file this payroll deduction with my employer and authorize my employer and associated agencies to deduct each pay period the amount certified in the box/space provided below as a voluntary contribution to the MAPE PAC. Amounts so deducted are to be remitted to MAPE within 30 days of the deduction. The deducted amounts will be used for the purpose of making political contributions and expenditures. I understand and agree that my contribution is voluntary, and is not a condition of membership in MAPE, or a condition of employment and I may decline to contribute without any reprisal. I understand that the contribution guidelines below are only suggestions, and that I am free to contribute more or less than the amount listed below. I understand that I may revoke my authorization at any time by giving written notice to MAPE. Contributions or gifts to the MAPE PAC are not tax deductible as charitable contributions. Check one of the following boxes: $1 per pay period $3 per pay period $5 per pay period Other amount per pay period Additional Contribution Other amount per pay period Sign below if you agree to the above terms of Section C Draw It Type It Clear Print your name + Terms for text me, call me! By providing my phone numbers, I agree that MAPE may periodically use automated calling technologies and/or text message me on my cellular phone or home phone. MAPE will never charge for text messages. Carrier message and data rates may apply. I can stop receiving automated calls or text messages by sending a written request to MAPE.