* = Required Field
Membership Authorization: Yes, I want to join my fellow employees and become a member of SEIU Texas! I request and voluntarily accept membership in SEIU Texas and its successors or assigns (collectively "SEIU TX"). This means I will receive the benefits and abide by the obligations of membership set forth in both SEIU TX's and the Service Employees International Union's Constitutions and Bylaws. I authorize SEIU TX 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 SEIU TX via U.S. mail (or other method if permitted by SEIU TX's 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 SEIU Texas and its successors and assigns (collectively "SEIU TX") an amount equal to the regular monthly dues uniformly applicable to members of SEIU TX. This authorization shall remain in effect unless I revoke it by providing notice to SEIU TX via U.S. mail (or other method if permitted by SEIU TX's policies) between 20 and 10 days prior to (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").
Contributions or gifts to SEIU Texas are not tax deductible as charitable contributions.
Last Four of SS#*
Date of Birth
Personal Email Address
Cell Phone Number†
Employee Start Date
†By providing my phone number, I understand that 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 TX and 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.
COPE Authorization: Hold Politicians Accountable: Yes! I want to hold politicians accountable to working families and I know we can only do that if we stand together. I hereby authorize my employer to withhold the indicated amount per month to forward to SEIU TX and its successors and assigns (hereinafter "SEIU") as a contribution to SEIU Committee on Political Education ("SEIU COPE"). My signature shows that I agree with the terms below
Please Specify Amount (Minimum $5)
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 of favor 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 via U.S. mail to SEIU.
Contributions or gifts to SEIU COPE are not tax deductible as charitable contributions.
Take Action: I want to step up and help build our union. We're only as strong as we are united.
Contact me about opportunities to get involved.