SEIU 521 Membership Card (Private Sector)

SEIU 521 Membership Card

Contact Information

First Name Last Name

Date of Birth

Street Address (Optional)

Postal Code City State/Province

Personal Email Mobile Phone† (Optional)

Yes, sign me up for text messages.

†By providing my phone number and clicking submit, I understand SEIU Local 521, the Service Employees International Union, its local unions, and affiliates may use automated calling technologies and/or text message me on my cellular phone on a periodic basis. SEIU will never charge for text message alerts. Carrier message and data rates may apply to such alerts. Reply STOP to stop receiving messages.

Employer

(Optional)

Job Information

Date of Membership Application

MEMBERSHIP APPLICATION

I, the undersigned, hereby designate Local 521, SEIU as my duly chosen and authorized agent to represent me in all matters relating to wages, hours and other conditions of employment with my employer. (Dues deduction is not effective until first contract is ratified.)

Signature

PAYROLL DEDUCTION AUTHORIZATION

I, the undersigned, do hereby authorize my employer to deduct from my salary or wages due or to become due me as such employee and further authorize payment of such deducted sums to Local 521 of SEIU to cover my membership and other fees that the union has notified the employer required to obtain and maintain membership.

This authorization applies to any changes in the amount of the dues and other fees of Local 521 and is to continue until termination of my employment or by written notice served by the undersigned on the union, or in accordance with the agreement between Local 521 and my employer, whichever is appropriate.

Signature

seiu521