Union Membership Form – Providence at Home with Compassus

Welcome to AaNA! Please fill out this form to choose your AaNA membership status and authorize payroll deduction by your employer.

When you submit this form, a copy of your responses will be sent to the email address you provided.

If you have any questions in filling out this form, please contact us.

Your Information

First Name*

Last Name*

Cell Phone*

Home Phone

Personal Email*

Mailing Address*

City*

State*

Zip*

WorkplaceInformation

Employer: Providence at Home with Compassus

Anticipated Hire Date: May 1, 2025

Unit/Department

Membership Status

Select one option below to choose your membership status.

OPTION 1: UNION MEMBERSHIP. Yes! I wish to become a full member of the Alaska Nurses Association, joining together with my colleagues to improve our lives at work, advocate for our profession, protect our patients, and lift up our community. I hereby accept membership in the Alaska Nurses Association and designate said union to act for me as collective bargaining agent in all matters pertaining to conditions of employment. I hereby pledge to abide by the Constitution and Bylaws of my bargaining unit and the Alaska Nurses Association. I hereby authorize my employer to deduct membership dues each pay period and remit my membership dues to the Alaska Nurses Association. I understand that I will pay the following in membership dues: a flat rate of $12.71 per pay period ($330.46 per year) AND 1% of my gross salary per pay period (up to a maximum of $600 annually).OPTION 2: REPRESENTATION ONLY. No, I do not wish to become a member of the Alaska Nurses Association. I understand that by choosing this option I will be forfeiting rights of membership. I understand that I as a non-member I cannot vote, run for office, serve in a leadership position, receive member discounts, or participate in member benefits programs. I understand that representation fees are determined annually by the Association’s audit and the Beck Audit percentage is 88.07% in 2025. I understand that I will pay the following in representation fees: a flat rate of $11.19 per pay period ($290.94 per year) AND 0.8807% of my gross salary per pay period (up to a maximum of $528.42 annually).

Payroll Deduction Authorization

I hereby authorize and direct my employer to deduct the above designated union dues or representation fees from my wages each pay period and remit all such deductions to the Alaska Nurses Association. I authorize my employer to deduct dues or fees according to the structure set by the Alaska Nurses Association. I understand that when I am on leave my union dues or representation fees will not be deducted during the time period I am not working, and that when I resume working, back dues/fees for the flat rate will be deducted for the time period during which I was on leave.

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Digital Signature Authorization

By typing my name in the field below, I acknowledge that I am electronically signing this form to select a membership option with the Alaska Nurses Association and have the above authorized dues/fees deducted from my wages by my employer.