Membership Card

What State is your Employer Located?*
What type of work do you do?*
Preferred Language*
Personal Information
First Name*
Last Name*
SSN (at least the last 4 digits)*
Birth Date*
Gender
Address Line 1*
Address Line 2
State*
City*
Zip Code*
Email
Home Phone
Cell Phone
Work Email
Employment Information
Employer*
Work Location
Job Title
Business Name
* By providing my phone number, I understand that the Service Employees International Union, its local unions, and affiliates may use automated calling technologies and/or text message me onmy cellular phone on a periodic basis. SEIU will never charge for text message alerts. Carrier message and data rates may apply to such alerts.
[Text STOP to 787753 to stop receiving messages.Text HELP to 787753 for more information.]
REQUEST FOR PAYROLL DEDUCTIONS FOR LABOR ORGANIZATIONS DUES
Privacy Act Statement
Membership Sign-Up & Authorization
Yes!
Dues Deduction / Check-off Authorization & Agreement
Yes!
Health Benefit Sign-Up & Authorization
Yes!
$10.95
$23.23
$27.53
Complete if spouse and/or children are included:
Full Name
Birth Date
Clear