Yes! I want to fight back to protect quality standards for home care workers and quality care for home care consumers. I agree to contribute $1.00 each month to the SEIU Fight Back Fund so we have the resources we need to fight for Home Care Workers and our Consumers.

Effective on the date of my signature above, I authorize Service Employees International Union Healthcare Illinois & Indiana (?SEIU?) to bill my debit card or credit card account or make withdrawals from my checking or savings account provided to SEIU, in order to initiate a recurring, automatic electronic funds transfer with my financial institution in the sum of $1.00 on the ?rst day of every month, as a contribution to the SEIU Fight Back Fund. In the case of checking and savings accounts, adjusting entries to correct errors are also authorized. I agree that these withdrawals and adjustments may be made electronically and under the Rules of the National Automated Clearing House Association. This authorization shall remain in effect until revoked by me in writing using the email address directpayrevocation@seiuhcil.org or other permitted method.

Contributions or gifts to SEIU are not tax deductible as charitable contributions.

Yes! I want to keep my Union strong by authorizing the automatic payment of an amount equal to Union dues from my debit card, credit card, or bank account as authorized below.

In the event my employer ceases payroll deductions of my dues, I authorize Service Employees International Union Healthcare Illinois & Indiana (?SEIU?) to bill my debit card or credit card account or make withdrawals from my checking or savings account provided to SEIU, in order to initiate a recurring, automatic electronic funds transfer with my financial institution, on the day after every payday designated by my employer, in an amount equal to one-half of 3.3% of my monthly gross earnings in the most recent month for which the State has provided such information to the SEIU. Because this amount is based on a percentage of gross earnings, the dollar amount deducted may change each month if my hours of work or rate of pay changes, and I agree to not receive any advance notice before the amount is billed or withdrawn as long as the amount is between $0 and $75 per month. The amount billed or withdrawn may change if a change in SEIU dues is authorized according to the requirements of the SEIU Constitution and Bylaws or the Service Employees International Union Constitution and Bylaws. If this happens, I authorize SEIU to initiate a recurring, automatic funds transfer in the amount of the new dues amount when notified by SEIU in writing of the new amount and with at least ten days' notice before the next funds transfer date. In the case of checking and savings accounts, adjusting entries to correct errors are also authorized. I agree that these withdrawals and adjustments may be made electronically and subject to the Rules of the National Automated Clearing House Association. SEIU will notify me of the transition to automatic payments (the "Transition Notice") at the current mailing address on file with SEIU prior to initiating the first payment via debit card, credit card, checking, or savings account, as authorized above. This authorization shall remain in effect until I revoke it in writing using the email address directpayrevocation@seiuhcil.org or other permitted method.
I acknowledge that failure to pay my dues on a timely basis may affect my membership standing in SEIU, as set forth in the SEIU Constitution and Bylaws or the Service Employees International Union Constitution and Bylaws.

Contributions or gifts to SEIU are not tax deductible as charitable contributions.

In the event my employer ceases payroll deductions for my contributions to the SEIU Committee on Political Education (?SEIU COPE?), I authorize Service Employees International Union Healthcare Illinois & Indiana (?SEIU?) to bill my debit card or credit card account or make withdrawals from my checking or savings account provided to SEIU, in order to initiate a recurring, automatic electronic funds transfer with my financial institution, on the day after every payday designated by my employer, in the amount indicated above for a contribution to SEIU COPE. SEIU will notify me of the transition to automatic payments (the ?Transition Notice?) at the current mailing address on file with SEIU prior to initiating the first payment via debit card, credit card, checking, or savings account, as authorized above. This authorization shall remain in effect until revoked by me in writing using the email address directpayrevocation@seiuhcil.org or other permitted method.
This authorization is made voluntarily based on my specific understanding that 1) I am not required to sign this form or make voluntary contributions to SEIU COPE as a condition of my employment or membership in the union; 2) I may refuse to contribute without reprisal;
3) Under law, only union members and executive I administrative staff who are U.S. Citizens or lawful permanent residents are eligible to contribution to SEIU COPE; 4) The contribution amounts on this form are merely suggestions, and I may contribute more or less by this or other means without fear of favor or disadvantage from SEIU or my employer; 5) SEIU COPE uses the money it receives for political purposes?including, but not limited to, making contributions to and expenditures on behalf of candidates for federal, state, and local offices?and addressing political issues of public importance.

Contributions to SEIU COPE are not deductible for federal income tax purposes.