City of LA Membership Card "*" indicates required fields Yes, I want to join my fellow employees and become a member of SEIU Local 721!First Name* Last Name* Street Address* City* State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingZip Code* Email* Mobile Phone* Preferred LanguageYour preferred languageEnglishSpanishTagalogOtherOther Language By providing my phone number, I understand that SEIU and its locals 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. Text STOP to 721721 to stop receiving messages. Text HELP to 721721 for more information.Membership Authorization Yes, I want to join with my fellow employees and become a member of SEIU Local 721. I hereby request and voluntarily accept membership in SEIU Local 721 and its successors or assigns (collectively, “SEIU”) and I agree to abide by its Constitution and Bylaws and by the SEIU Constitution and Bylaws. I authorize SEIU to act as my exclusive representative in collective bargaining over wages, benefits, and other terms and conditions of employment with my employer. I know that membership in the union is voluntary and is not a condition of my employment, and that I can decline to join without reprisal.Signature*Today’s Date 10/15/2024Payroll Deduction Authorization I enter into this agreement in return for the privileges of SEIU Local 721 membership and the long-term benefit of union representation. I direct my employer to deduct membership dues from my earnings, and to transfer that money to SEIU Local 721 and its successors or assigns (collectively “SEIU Local 721”). I can end my membership by submitting a signed resignation letter to SEIU Local 721’s central office, or as otherwise allowed by law. I understand that both union members and nonmembers benefit from representation and should contribute. Even if I resign my union membership, I nevertheless agree voluntarily to contribute my fair share by paying an amount equal to dues. I direct my employer to deduct this amount from my earnings and to transfer that money to SEIU Local 721. I understand that this voluntary authorization shall renew each year on the anniversary of the date I sign below, unless I send a signed revocation letter to SEIU Local 721’s central office by U.S. Mail (or as otherwise allowed by law) within 15 days before or after (1) the annual renewal of this agreement or (2) the termination of the applicable collective bargaining agreement between my employer and union This authorization is voluntary and is not a condition of my employment, and I can decline to agree to it without reprisal. This dues authorization will remain effective if my employment with the employer ends and I am later re-employed by the employer. Contributions or gifts to SEIU are not tax deductible as charitable contributions.Signature*Today’s Date 10/15/2024PhoneThis field is for validation purposes and should be left unchanged.
