A. I wish to join MAPE. I wish to authorize payroll deduction of my dues. * 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! (see terms below) Home phone Home email Work phone Work email * Agency / Dept. Name * Recruited by I hereby request membership with and authorize the Minnesota Association of Professional Employees (hereinafter “MAPE”) to represent me for the purpose of collective bargaining with my employer and to negotiate and conclude all agreements respecting wages/salaries, hours and other conditions of employment. Additionally, I hereby request and voluntarily authorize my employer to deduct from my earnings of an amount sufficient to provide for the regular payment of dues in the amount established by MAPE. The amount shall be certified by MAPE and any changes in such amount shall also be so certified. This amount shall be deducted at least monthly. I further authorize my employer to send my deducted dues to MAPE for and on my behalf. This authorization and assignment is voluntarily made in consideration for the cost of representation and collective bargaining by the Union as my exclusive representative and is not contingent upon my present or future membership in the Union or a condition of my employment. I understand and agree that my authorization of dues deduction 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. In the absence of such notice or revocation sent and received in accordance with the foregoing, this authorization shall be irrevocably renewed for an additional annual period and for successive annual periods thereafter in accordance with the foregoing. The invalidity or unenforceability of any particular provision hereof shall not affect the other provisions, and this authorization agreement shall be construed in all respects as if such invalid or unenforceable provision were omitted. By providing my personal phone number, I understand that MAPE may use automated calling technologies on a periodic basis to contact me. I also understand that I can have my phone number removed from MAPE’s automated calling system by contacting MAPE in writing and requesting that my phone number be removed from the automated call list. Sign below if you agree to the above terms of Section A * Draw It Type It Clear Print your name B. Join and contribute to Team MAPE (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 is free of 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 my donation amount will not be favored or disfavored due to the amount of the contribution or for my refusal to contribute. I understand that I may revoke my authorization at any time by giving written notice to MAPE. $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 B Draw It Type It Clear Print your name C. Text Message Terms I understand that MAPE may send up to seven text messages each month to the phone number provided. I also acknowledge standard messaging and data rates may apply.