SEIU 721
Southern California Public service Workers
SEIU 721 Membership Application.
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EmployeeID
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LastName
FirstName
M.I.
DateOfBirth
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State
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Item#
JobTitle
HireDate
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Dept#
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Facility Name
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City
State
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Unit/Floor/Room/Other
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I agree to The 
COPE Agreement
By providing my phone number, I understand that SEIU and its locals 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 [any text from us or 787753] to stop receiving messages. Text HELP to 787753 for more information.
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COPE Agreement
This authorization is made voluntarily based on my understading that: 1) I am not required to sign this form or make COPE contributions 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 amount 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 Local 721. This authorization will remain effective if my employment with the employer ends and I am later re-employed by the Employer. Contributions or gifts to SEIU COPE are not tax deductible as charitable contributions.
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