SEIU 521 Membership Application

Step 2 of 6: Authorization Card

Yes! I want to join with child care providers throughout California to make my voice heard.

I authorize Child Care Providers United California (CCPU-CA), a joint partnership of SEIU and AFSCME, to act as my representative in collective bargaining, and as my exclusive representative where authorized by law. I understand that when child care workers win the right to collectively bargain, CCPU-CA may request recognition from the State of California to represent me in bargaining with respect to my subsidy payments, terms, and conditions of my work as a child care provider.
I understand that this authorization card may be used to seek an election or obtain recognition from the State.

First Name*
Middle Name
Last Name*
Zip Code*
Home Phone
Cell Phone†
Work Phone
Work Email
Business Name

†By providing my phone number, I understand that CCPU-CA/SEIU 521, 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. CCPU-CA/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.