Home Care Workers Are Stronger Together!

Please complete this form to commit to your fellow home care workers across PA that you're united with them. By doing so, you will commit to sustaining the work we accomplish together with your union membership.

Yes, I want to to build a strong organization for home care workers!

I hereby apply for membership in the United Home Care Workers of Pennsylvania (UHWP), a joint partnership of SEIU Healthcare PA, 1199C/NUHHCE, and AFSCME Council 33. Membership in UHWP is completely voluntary and may be revoked by me at any time by contacting UHWP.

First Name *

Last Name *

E-Mail *

*Phone

Street Address *

Zip Code *

Employer

Your Signature *

Full name for signature

Date *

YYYY

*Including your mobile number will you enroll you in our rapid response text message system. By including your mobile number, you are authorizing United Home Care Workers of PA and its affiliated locals, using various automated technologies, to call you and get text alerts to you – up to 5 per month. We will never charge you for text messages, but carrier message & data rates may apply. Reply ‘STOP’ to unsubscribe, and ‘HELP’ for more info.

Membership Dues Deduction Authorization *

I authorize my employer and/or the payroll processing agent preforming fiscal management services for my employer to deduct each month from my wages my voluntary membership dues in the amount of 2% of my earnings and to remit all deductions to UHWP. I understand that membership dues are completely voluntary and that this authorization may be revoked by me at any time by contacting UHWP.

Required

Signature *

Full name for signature

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