One Click Opt-Out

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Email*

Please enter the best email address at which to contact you. Our representative will be contacting you to confirm the details about your enrollment in our One Click Opt Out Program.

Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

HR Department Email Address

As part of the opt out process, we will email one copy of your opt out letter to your Human Resources department, or the department that is in charge of your paycheck. Please list an email address for your HR Department or the department in charge of your paycheck.

HR Department Contact Name

As part of the opt out process, we will email one copy of your opt out letter to your Human Resources department, or the department that is in charge of your paycheck. Please list a contact name for that person.

Employer Name*

Full name of your employer (i.e., your workplace or the company that issues your paycheck).

Select Your Union*

Please select your union from the list below. If you do not know the name of your union or do not see it below, please email us at info@employeefreedommn.com for help.

Signature*

By signing my name, I affirm that I am the person named above. I understand that exercising my Janus Rights means I will no longer be a member of the union and won't receive certain union services, but that this will not affect any employer-paid fringe benefits such as medical insurance, retirement, vacation or leave credits, etc. I authorize the sending of the letter linked above to the union and to my employer and agree to email info@EmployeeFreedomMN.com if/when I receive a reply from the union and/or my employer.

Employer Information