SEIU Local 503 Membership Application

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Employer Type

First Name

Last Name

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Day

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Address

Home Street

Please enter your physical street address here, not a P.O. box. There is a space for a mailing address on the next page, if different from your physical address.

Home City

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Home ZIP code

Home Email

Please use your personal email if you have one, since some employers limit union communication via work email. If you don't have a personal email, work email is fine. If you don't have an email address, call us at 1.844.503.7348 to sign up over the phone.

Mobile Phone

† By providing my phone number, I understand that the Service Employees International Union (SEIU), 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; reply HELP for more information.

OPT OUT OF RECEIVING MOBILE ALERTS†

Membership Authorization

I request and voluntarily accept membership in SEIU Local 503 and its successors or assigns (collectively “Local 503”). This means I will receive the benefits and abide by the obligations of membership set forth in both Local 503’s and the Service Employees International Union’s Constitutions and Bylaws. I authorize Local 503 to act as my representative in collective bargaining over wages, benefits, and other terms/conditions of employment with my employer, and as my exclusive representative where authorized by law. My membership will be continuous, unless I resign by providing notice to Local 503 via U.S. mail (or other method if permitted by Local 503 policies). I know that union membership is voluntary and not a condition of employment, and that I can decline to join without reprisal.

Dues Deduction/Checkoff Authorization

I request and voluntarily authorize my employer to deduct from my earnings and to pay to Local 503 and its successors and assigns (collectively “Local 503”) an amount equal to Local 503’s regular dues, and other fees or assessments uniformly applicable to members of Local 503. This dues deduction authorization shall remain in effect unless I revoke it by providing notice to Local 503 via U.S. mail (or other method if permitted by Local 503’s policies) within 15 days before or after (1) the annual anniversary date of this agreement or (2) the termination of the applicable collective bargaining agreement between my employer and union (“my window periods”). This authorization will renew automatically from year to year even if I have resigned my membership, unless I revoke it during one of my window periods and as required by Local 503’s policies. This authorization is voluntary and is not a condition of my employment, and I can decline to agree to it without reprisal. I understand that all members benefit from everyone’s commitments because they help build a strong union that is able to plan for the future.

Check this box if you would like the portion of dues spent on political power to go toward SEIU 503’s scholarship fund.

SIGNATURE

Your full legal name

Enter your full legal name. This will act as your signature.