SEIU 521 Membership Application

Step 2 of 6: Authorization Card

I hereby authorize Child Care Providers United California (CCPU-CA), a joint partnership of SEIU and AFSCME, as my exclusive representative for the purposes of collective bargaining. 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 obtain recognition from the State with or without an election.

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 SEIU521, the Service Employees International Union, 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. Text STOP to 787753 to stop receiving messages.