New York StatePUBLIC EMPLOYEESFEDERATION AFL-CIO1168-70 Troy-Schenectady RoadP.O. Box 12414Albany, NY 12212-2414(518) 785-1900(800) 342-4306Fax (518) 785-1814Welcome To PEFOFFICERS:Wayne SpencePresidentKay Alison WilkieSecretary-TreasurerSharon V. DeSilvaRandi DiAntonioVice PresidentsREGIONALCOORDINATORS:Michele SilsbyRegion 1Andrew PuleoRegion 2Welcome to the NYS Public Employees Federation, PEF!We are asking you to please sign up as a PEF member. Here’s why:Being a PEF member will give you a voice on the job and in the community.Our union advocates for the work we do because our work protects and improves the qualityof life for all New Yorkers.We tell state decision makers and elected officials how and why our work is essential.David DubofskyRegion 5We advocate for New Yorkers and the professional work done by PEF members withmembers of Congress and federal decision makers. That is why there is a VOTE/COPE signup card in this orientation packet – so you can become an active participant in PEF’s effortsto defend and extend the funding and support that our work receives from federal resources.Please mail it back to us today along with other relevant material.Victoria StocktonRegion 6 AdvocateRegion 6In addition, being a PEF member gives you a voice in many workplace issues:VacantRegion 3Roberta (Bobbi) StaffordRegion 4Virginia (Gini) DaveyRegion 7Michael BlueRegion 8Diane JaulusRegion 9Darlene WilliamsRegion 10Bernadette O’ConnorRegion 11Nora HigginsRegion 12TRUSTEES:Christopher BumanJeanette SantosMaddie Shannon-Roberts1. You can vote on the contracts that affect your rights on the job, your negotiated healthbenefits and other quality-of-life issues.2. You can help elect co-workers who will represent you on the job, or even better, you canbecome an elected union representative yourself so the needs and concerns ofyour co-workers are heard and acted upon.3. You will be a member of an active organization that seeks out members to participate in avariety of ways. Your voice matters in PEF.As a PEF member, you will also be entitled to take advantage of many “no cost” anddiscounted benefits through the PEF Membership Benefits Program (MBP). Benefitsprovided by the PEF MBP are not funded by PEF dues. One of the most valuable benefitsis the insurance offering provided by Sun Life. Plese see other side for details.Affiliated with the American Federation of Teachers, AFL-CIO and Service Employees International Unionplease see other side

New Employees Have 240 Days To Enroll In The Group Term Life, Short-TermDisability And Long-Term Disability Insurances.Enclosed is a brochure and the enrollment application for these important insurances. It is important to notethat by enrolling in these coverages during your first 240 days of employment, you will not be required to submitmedical documentation for approval. Please review the brochure and contact the PEF Membership BenefitsProgram with any questions you may have. You should be aware that New York State employees are notcovered by NYS disability insurance, so this insurance may be of great value to you.During your first 240 days, you can apply for:* Group Term Life Insurance – Up to 3 times basic annual earnings on yourself and up to 20,000on your spouse and 15,000 per dependent child Short-Term Disability – A weekly benefit of up to 400 Long-Term Disability – 50% or 60% of your current monthly income in coverageWe encourage you to visit the PEF website at to learn more about PEF. If you have any questionsabout the insurance benefits, contact the PEF Membership Benefits Program at (800) 342-4306, ext. 243 orvisit again, on behalf of our more than 50,000 members, we welcome you to the PEF family!In Unity,Wayne Spence, PresidentNYS Public Employees FederationKay Alison Wilkie, Secretary-TreasurerNYS Public Employees Federation*NOTE: See enclosed brochure for further details.2.9.21

New York State Public Employees Federation, AFL-CIOPEF Membership Application andDues Payroll Deduction AuthorizationTO BECOME A MEMBER .Complete this application form and mail it to PEF HeadquartersPO Box 12414 Albany, NY 12212-2414 Attn: MIS.Please print LEGIBLY:Last NameFirst NameM.I.First Line Street AddressSecond Line Street AddressCityStateZip Code( ) - ( ) - / /Home Telephone No.Work Telephone No.Date of Birth (MM / DD / YYYY)PEF Online Information Get valuable updates via email or text message IMPORTANT: Personal emails are required due to New York State restrictions on the use of work emails.Email Address (please print) @Phone for Text: () - (Note: Texting fees may apply)By providing the information above, you are giving PEF and PEF Membership Benefits Program (PEF MBP) permission to contactyou regarding PEF union notices (e.g., PEF ON THE MOVE which provides notices on contract benefits/benefit changes, issuesaffecting terms and conditions of employment, contract negotiations, as well as PEF MBP benefit updates). You can opt-out of theseat any time.Check every activity in which you might participate: Social Activities Letter Writing Contract Solidarity Division Membership Meetings Demonstrations Welcome Committee Member Mobilizer Other:Additional Information Have you received an orientation to PEF? No Yes – when (date): Have you served in the U.S. Military? No YesYou can apply online @ you can send this form byFax to: 518-252-4050Email to: [email protected] to: Membership Information ServicesNew York State Public Employees FederationPO Box 12414Albany, NY 12214-5551Membership Authorization, Dues Deduction/Checkoff AuthorizationMembership Authorization: Yes, I want to join with my fellow employees and become a member of PEF. I hereby request and voluntarily acceptmembership in PEF and I agree to abide by its Constitution and Bylaws. I authorize PEF to act as my exclusive representative in collectivebargaining over wages, benefits, and other terms and conditions of employment with my employer.SIGNATURE DATEDues Deduction/Checkoff Authorization: I recognize the need for a strong union and believe everyone represented by our union should pay theirfair share to support our union’s activities. I hereby request and voluntarily authorize the Comptroller of the State of New York and/or my employerto deduct from my earnings and to pay over to PEF an amount equal to the regular monthly dues uniformly applicable to members of PEF, in theamount certified by PEF in this and succeeding years of my employment. This authorization shall remain in effect and shall be irrevocable unlessI revoke it by sending written notice via U.S. mail to PEF during the period not less than thirty (30) days and not more than forty-five (45) daysbefore the annual anniversary date of this agreement or the date of termination of the applicable contract between the employer and PEF, whicheveroccurs sooner. This authorization shall be automatically renewed as an irrevocable check-off from year to year unless I revoke it in writing duringthe window period, even if I have resigned my membership in PEF.SIGNATURE DATENM 4.23.18

Leverage Your PowerCOPE . Most often asked questionsQ What is COPE?A COPE (Committee on Political Education) is apolitical action fund financed by voluntarymember contributions separate fromthe PEF budget.Q Is COPE really necessary?A COPE is a key part of PEF’s effort to strengthenour role on the political stage and gain morerespect for NYS public employees. This will helpus influence more of the decisions made bygovernment that affect public employees andtheir families.Q Where does the money go?A COPE is used to financially support candidatesfor federal elected office.Q Why doesn’t my union dues support thisprogram?A Federal Law prohibits PEF from using union duesto support federal campaigns.Q Who decides who gets our support?A The PEF Executive Board and the StatewidePolitical Action Committee (SWPAC) carefullyreview candidate platforms and baseendorsements on their position on key laborissues that directly impact public employees.Q Is my contribution going to make a difference?A Yes! Joining COPE builds the union’s power tofight for federal funds that benefit our members’jobs and the quality services they provide to NewYork State’s residents.Q How do I participate in COPE?A Fill out and return the Authorization for VoluntaryCOPE Deduction on the front of this card.Thank you for your contribution!PEF Legislative Office90 State Street, Suite 1029Albany, NY 122071-800-724-4997

Last5. DepartmentJob TitleApt. No.FirstATTN: MIS DEPT.City2. Amount Per Pay Period. 10.00 6. Signed Up By State 5.00 Zip CodeInitial 8. Sign your full name, and fill in the date. 20.005. Your department and title.6. Who asked you to be a COPE contributor?7. Effective date (date you want check off to begin). LCC 4.1.167. Effective no earlier than (enter date)l hereby authorize regular payroll deductions from my earnings in the amount specified hereon as a voluntary contribution to be paid to the Treasurer of PEF COPE, to be used in accordancewith applicable federal and state laws for political purposes including but not limited to addressing political issues of public importance and contributing to federal elections. My contribution is voluntary, and I understand that: a) it is not required as a condition of employmentor membership in the union; b) I may refuse to contribute without reprisal; c) I may revoke this authorization at any time by giving written notice to the Treasurer of PEF COPE and/or my payroll office, such revocation being effective when accepted into the employer’s payroll system. Thisauthorization supercedes all previous authorizations.Only union members and executive/administrative staff of the union who are U.S. citizens or lawful permanent residents are eligible to contribute to PEF COPE; the contribution amounts on this form are merely suggestions. I may contribute more or less by this or some other means withoutfear of favor or disadvantage from the union or my employer;A copy of the New York State Public Employees Federation COPE report is filed with the Federal Election Commission and is available for purchase from the Federal Election Commission, Washington, D.C. Copies of these reports are also on file with the New York State Board of Elections,Albany, New York. Contributions to PEF COPE are not deductible as charitable contributions for federal income tax purposes.8. Signature8. Date2. Check / state amount you want deducted fromeach paycheck for PEF COPE.3. Print last and first name.4. Your home address.INSTRUCTIONS FOR COMPLETING PEF COPE CHECK OFF CARDNEW YORK STATE PUBLIC EMPLOYEES FEDERATION, AFL-CIO1168-70 TROY-SCHENECTADY ROAD P.O. BOX 12414 ALBANY, NEW YORK 12212-2414PEF COPEMAIL TO:Street & No.1. MIN# (See #1 under“Instructions” below)1. Your MIN# (Member Identification Number) canbe found under the barcode on PEF ID card orcall 800.342.4306, ext 243.4. Home Address:3. Name:PRINT CLEARLYMAIL-IN AUTHORIZATION FOR VOLUNTARY COPE PAYCHECK DEDUCTION

Affiliations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AFT/SEIUA Union of ProfessionalsSERVICE EMPLOYEESINTERNATIONAL UNIONAFL-CIO, CLCAMERICAN FEDERATIONOF TEACHERS AFL-CIOAFT BenefitsThrough our affiliation with the American Federationof Teachers (AFT), PEF members are eligible for thefollowing benefits:SEIU BenefitsThrough our affiliation with the Service EmployeesInternational Union (SEIU), PEF members are eligiblefor the following benefits: Scholarship Programs Mortgage Assistance Program Mortgage Program SEIU Scholarship Programs Flower Discounts Credit Card Magazine Discounts Union Made Checks Health Clubs Health Club Discounts Powell’s Online Bookstore AFT Credit CardFor additional information, contact AFT at(800) 238-1133 or and click on “MemberBenefits” and then “Your Benefits.” You will need toidentify yourself as an AFT Local 4053 member.For additional information, contact Union Plusat (800) 452-9425 or visit and look under Resources.You will need to identify yourself as an SEIU Local4053 member.The Public Employees Federation does not endorse the benefits made available to you through AFT or SEIU. The benefitshave NOT been researched or investigated by PEF Membership Benefits Program. Questions or problems with the abovelisted benefits must be directed to either AFT or SEIU depending on the benefit.

Sun Life and Health Insurance Company (U.S.)One Sun Life Executive Park, Wellesley Hills, MA 02481 800-247-6875Group Enrollment form for Voluntary Group Term Life, Accidental Deathand Dismemberment, Short-Term Disability Income, and Long-TermDisability Income Insurance1 General informationPolicyholder namePEF Membership BenefitsStreet address10 Airline Drive, Suite 101Type of activity:New EnrollmentReason:Account number819927CityAlbanyStateNYZip code12205Change2 Member informationDate of BirthMaleFemaleStateZip CodeMember’s Full Legal Name (First, MI, Last)Street AddressCityMarital StatusMember Status:Email AddressActive UnionPhone numberMember ID #:RetiredYou need to complete all sections of the enrollment form and sign it. This must be done either during the enrollment periodor within 120 days of your eligibility date. Not all of the benefit options listed below will be necessarily available to you. PEFMembership Benefits Program will inform you which benefits are available. If after 120 days, please complete an onlineEOI, at Benefit electionsVoluntary Life and Accidental Death & Dismemberment (AD&D) coverage:Member1Spouse and Child(ren)Child(ren) 20,0001X BAE2X BAE**BAE Basic Annual Earnings 20,000 15,0003X BAE11*Spouse and Child(ren) may only be covered if Member is enrolling in, or already has a policy on themselves. Spouse and1Child(ren) are not eligible for Voluntary AD&D. Your Spouse and Child(ren) cannot elect more than 100% of your amount ofInsurance.Disability coverage:Member Short-Term Disability. 100Member Long-Term Disability .50%PEF Membership Benefits (1/16) 200 300 40060%Enrollment FormPage 1 of 5

4 Dependent informationPlease complete this entire section if you are selecting dependent coverage.RelationshipFull Legal Name (First, MI, Last)GenderDate of Birth1Spouse /PartnerChildrenI understand Spousal/Domestic partner coverage is for married individuals or those who have executed domesticpartnership forms on file with PEF Membership Benefits Program. If I have a change in my marital status, I mustcontact PEF Membership Benefits Program as soon as possible.I understand dependent children must be under the age of 19 years old or unmarried and under the age of 25 andenrolled as a full-time student and who depends on me for 50% or more for his/her support. Not applicable to Dental.5 Beneficiary Designation informationPrimary Beneficiary DesignationVoluntary Life and AD&D Insurance – On the lines below, list the individual(s) who should receive proceeds in the event ofyour death. You may specify as many individuals as you like, but the total proceeds must equal 100%. If you do not name abeneficiary or if no beneficiary is alive at the time of your death, proceeds will be payable in accordance with your GroupInsurance Certificate.Percent shareof proceeds1 Name (First, M.I., Last)Relationship to MemberSocial Security number%AddressPhone numberDate of birth2 Name (First, M.I., Last)Relationship to MemberSocial Security numberAddressPhone numberDate of birth3 Name (First, M.I., Last)Relationship to MemberSocial Security numberAddressPhone numberDate of birthPEF Membership Benefits (1/16)Enrollment Form%%Page 2 of 5

5 Beneficiary Designation information, continuedSecondary Beneficiary DesignationVoluntary Life and AD&D Insurance– On the lines below, list the individual(s) who should receive the proceeds ONLY IFALL of the individuals listed above as your primary beneficiary(ies) are not living at the time of your death. This is yoursecondary (or contingent) beneficiary. The secondary (or contingent) beneficiary is not paid if your primary beneficiary(ies) isalive at the time of your death.Percent shareof proceeds1 Name (First, M.I., Last)Relationship to MemberSocial Security number%AddressPhone numberDate of birth2 Name (First, M.I., Last)Relationship to MemberSocial Security numberAddressPhone numberDate of birth3 Name (First, M.I., Last)Relationship to MemberSocial Security numberAddressPhone numberDate of birth%%6 Evidence of insurability and authorization informationA medical Evidence of Insurability (“EOI”) application will be required for any Member and/or dependent who applies forcoverage more than 120 days past his/her eligibility date. An EOI application is also needed if you: apply for a higher coverage than the Maximum Guaranteed Issue amount during an open enrollment period want to increase your existing coverage now or at a later date, Whether your existing coverage is with Sun Life andHealth Insurance Company (U.S.) or a prior insurance carrier decline coverage and then want it at a later dateCoverage subject to evidence of insurability will not go into effect until Sun Life and Health Insurance Company (U.S.)approves it.Website to complete the online EOI: Membership Benefits (1/16)Enrollment FormPage 3 of 5

6 Evidence of insurability and authorization information, continuedI understand that: I am requesting coverage under a Group Insurance policy. My policyholder will deduct all or part of the premium for contributory coverage from my pay, pension, EFT, or DirectBilling through invoice. If I decline coverage for myself or, if applicable, for my family now and want it at a later date, I/we will have to submitan Evidence of Insurability application which is acceptable to Sun Life and Health Insurance Company (U.S.). I haveread the Evidence of Insurability notice. Accelerated Benefits: Receipt of accelerated death benefits may affect eligibility for public assistance programsand may be taxable. If you have received an accelerated benefit, your life insurance will be reduced by an amountequal to the accelerated benefit paid by Sun Life and Health Insurance Company (U.S.). If I am not actively at work due to injury, illness, layoff or leave of absence on the date that any initial or increasedcoverage is scheduled to start under the plan, such coverage will not start until the date I return to work. When required by the coverage, if my spouse or any of my dependent children are confined due to an injury orillness, as required by the coverage, on the date that any initial or increased coverage is scheduled to start under theplan, such coverage will not start until the date they are no longer confined and are able to perform their normalactivities.By signing below, I am representing that the information I have provided is true and correct to the best of my knowledgeand belief.I have read or had read to me the fraud warning for my state.Does not apply to Life Insurance. Any person who knowingly and with intent to defraud any insurance company orother person files an application for insurance or statement of claim containing any materially false information, orconceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulentinsurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars andthe stated value of the claim for each such violation.XToday’s DateMember SignaturePEF Membership Benefits (1/16)Enrollment FormPage 4 of 5

To the Member: Make a copy of this form for your records before submitting it to:PEF Membershi