ONA Authorization Form and Membership Application

Asante Rogue Regional Medical Center Allied Health Workers

The Oregon Nurses Association (ONA) is one of the largest and most influential nursing and health care worker associations in the state. In our more than 100 year history, ONA has changed the face of health care in Oregon by improving working conditions for nurses and health care workers, advancing practice, and protecting patients' rights.

First Name *

Middle Initial

Last Name *

Pronouns

Home Mailing Address *

City *

State *

Zip Code *

Personal Email Address (No work email please) *

Please confirm your email address *

Cell Phone

Home Phone

Oregon license or other certification number

Credentials or Job Class/Title

Work Information

Work Location

Unit / Branch *

Shift / Team

Work Phone

Secondary employer (if applicable)

Authorization for Representation

I, the undersigned, hereby designate Oregon Nurses Association as my duly authorized representative for the purposes of collective bargaining concerning my wages, hours and other conditions of employment. *

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Membership Application

To become an ONA member once the first contract is ratified, please complete the following payment information. Please note, you will not be charged any dues until after the first contract is ratified.

Choose Payment Method (upon contract ratification)

Payroll Deduction

Payroll Deduction

By choosing this option, I authorize my employer to deduct an amount as certified by the Oregon Nurses Association as the current amount of the ONA dues from my earnings each year, according to the employer’s payroll deduction period, beginning with the next payroll period and shall automatically renew itself for successive yearly or applicable contract periods.

ONA 2022-2023 Dues Rates

Upon ratification of the contract, the base membership dues for ONA are calculated at a yearly rate. The dues deducted are shown here before any applicable BU or CA fees or special reduced dues discounts for which you may qualify.

ONA Membership: 1.4% of wages calculated on all
straight-time hours worked with a maximum of $43.57 per pay period*

* Dues will not be charged until after the first contract is ratified.

Membership includes ONA, AFT, local ONA Constituent Association, Oregon AFL-CIO, ON-PAC, NU-PAC, and bargaining unit assessment where applicable. Please send a letter to ONA if you do not want a portion of your dues to go to ONPAC and/or to NU-PAC and instead direct ONA to deposit that amount in the ONA General Fund.

ONA members shall be considered delinquent and rights shall be forfeited upon failure to pay dues or fees as required by current policy. No monies shall be refunded or additional monies collected retroactively when a change of dues category is made within a membership year.

You have the right to refrain from becoming a member of the Union. If you choose this option, you will be able to satisfy requirements of a contractual union security provision, if any, by paying the equivalent of monthly dues to the Union. In addition, non-members who object to payment in full of the equivalent of dues and fees will be able to file written objections to funding expenditures that are not germane to the Union’s duties as your agent for collective bargaining.

Communications and Confirmation

ONA Email Communications

YES, I would like to stay informed and receive EMAILS from ONA regarding my bargaining unit, contract negotiations, organizational news, events and more.

ONA Text Message Communications

YES, I would like to stay informed and receive TEXTS from ONA regarding my bargaining unit, contract negotiations, organizational news, events and more.

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