Union Membership Form – Alaska Nurses Association

Welcome to AaNA! Fill out this form to become a member of the Alaska Nurses Association and authorize payroll deduction of membership dues by your employer.

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

Please note: This form is only for use by non-members paying representation fees who wish to change their membership status to become members of AaNA. If you are a new hire, please contact us to complete your initial paperwork.

Your Information

First Name*

Last Name*

Mailing Address*

City*

State*

Zip*

Cell Phone

Home Phone

Personal Email*

Workplace Information

Employer*

Unit/Department

Hire Date*

Become a Member of our Union!

Yes! I wish to become a 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).

Payroll Deduction Authorization

I hereby authorize and direct my employer to deduct the above designation from my wages or salary, and to remit all such deductions so made to the Alaska Nurses Association. My employer is authorized to deduct dues according to the fee structure set by the Alaska Nurses Association. I understand that when I am on leave my union dues will not be deducted during the time period I am not working, and that when I resume working, back dues for the flat membership dues will be deducted for that time.

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Digital Signature

By typing my name in the field below, I acknowledge that I am electronically signing this form to become a member of the Alaska Nurses Association and have the above authorized dues deducted from my wages by my employer.