SEIU 775

YES, I want to join with long-term care workers for a stronger voice for quality care, living wages, and good benefits!

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*By providing my telephone number, I understand SEIU 775, SEIU, and affiliates may use automated calling technologies and/or text message me on my cell 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 or HELP to 787753 for more information.


I support the organization’s mission of uniting caregiver strength toward a more just and humane world and I hereby request and accept associate membership in SEIU 775. I will work to fulfil the vision of lifting all caregivers out of poverty and of providing quality care for all those we serve. I agree to pay $15 per month in Union dues required for associate membership as established by SEIU 775 under its Constitutions and Bylaws. I understand that members could vote to change that amount; if that happens the Union will notify me of the change and request a new authorization.

Contributions or gifts to SEIU 775 are not tax deductible as charitable contributions for Federal income tax purposes.

  1. I am at least eighteen years old.
  2. I have reviewed the Privacy Policy and Terms of Service.
  3. I understand that union dues, contributions or gifts to SEIU 775 are not tax deductible as charitable contributions.
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X 12/05/2020



I authorize SEIU 775 to charge my credit/debit card indicated on the form each month for payment of my $15.00 Associate Membership dues. I understand that this authorization will remain in effect until I cancel it in writing, and I agree to notify SEIU 775 in writing of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. Billing will occur on the same day of the month as original transaction unless requested otherwise. I agree not to dispute this recurring billing with my bank so long as the transactions correspond to the terms indicated in this authorization form.

Withdraw dues on day every month.

Yes! I want to hold politicians accountable to working families and I know we can only do that if we stand together. In addition to monthly dues, I will contribute monthly to COPE.

I hereby authorize SEIU 775 (“Union”), to withhold the indicated amount per month as a contribution to SEIU Committee on Political Education (“SEIU COPE”). My signature shows that I agree with the terms below.

This authorization is made voluntarily based on my specific understanding that: (1) I am not required to sign this form or make voluntary contributions to SEIU COPE as a condition of my employment or membership in the union; (2) I may refuse to contribute without reprisal; (3) Under law, only union members and executive/administrative staff who are U.S. Citizens or lawful permanent residents are eligible to contribute to COPE; (4) the contribution amounts on this form are merely suggestions, and I may contribute more or less by this or other means without fear or disadvantage from SEIU or my employer; (5) SEIU COPE uses the money it receives for political purposes – including, but not limited to, making contributions to and expenditures on behalf of candidates for federal, state, and local offices – and addressing political issues of public importance. This authorization shall remain in effect until revoked by me in writing to SEIU via U.S. mail.

Contributions or gifts to SEIU COPE are not tax deductible as charitable contributions.

Total Payment: $15 to be charged monthly
Please use your mouse or finger to draw your signature in the box below.
X 12/05/2020