Associate Member Application

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Join and Grow

Join together for a stronger voice in our communities.

Contact Information

Your Name(Required)

First Last

Your Address

Street Address Address Line 2 City State ZIP Code

Date of Birth

Personal Email

By providing my phone number, I understand the State Employees’ Association, the Service Employees International Union, and its affiliates may use automated calling technologies and/or text messaging 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 787753 to stop receiving messages. Text HELP to 787753 for more information. By providing my email address, I agree to receive periodic e-mails.

Phone (Home)

Phone (Cell)

Additional Information

Please fill in your employment information

Employer

Occupation

Email (Work)

Phone (Work)

Worksite ( Optional)

Employment

Who referred you to the SEA?

MEMBERSHIP AUTHORIZATION: Yes! I want to join with my fellow employees and become a member of SEA/SEIU Local 1984 (“SEA”). I hereby request and voluntarily accept membership in SEA and I agree to abide by its Constitution and Bylaws and by the Service Employees International Union Constitution and Bylaws.

Signature