Online Authorization Card

Yes, I want to join with my coworkers and become part of the New York Professional Nurses Union in order to negotiate improvements in our work place.

Date*
MM slash DD slash YYYY
Name*
First Last
Primary Phone*
Primary Phone Type
Email*
Secondary Phone
Address*
Street Address Address Line 2 City State ZIP Code
Work Site*
Job Title*
Shift*
Your right to sign this card is strictly protected by state and federal law.

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