SEIU 521 Membership Application

I request and voluntarily authorize Child Care Providers United California (“CCPU-CA”), a joint partnership of SEIU and AFSCME and its successors or assigns, to act as my representative in collective bargaining with respect to my subsidy payments, and other terms and conditions of my work as a child care provider, and as my exclusive representative where authorized by law. I also request and voluntarily accept membership in CCPU-CA and SEIU Local 521 (“Local 521”). This means I will receive the benefits and abide by the obligations of membership set forth in the Constitutions and Bylaws of CCPU-CA, Local 521, and the Service Employees International Union (“SEIU”). My membership will be continuous, unless I resign by providing notice to Local 521 via U.S. Mail (or other method permitted by Local 521’s policies). I know that membership in CCPU-CA and Local 521 is voluntary and is not a condition of my work as a child care provider, and that I can decline to join without reprisal.

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

† By Providing my phone number, I understand that CCPU-CA/Local 521, the Service Employees Internation 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/Local 521 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.