SEIU Local 535

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SEIU535 RETIRED MEMBER/AFFILIATE ON-LINE FORM

Yes, I want to retain my affiliation with SEIU Local 535 upon my retirement.  I want to be( please choose one):
  Retired Member ($8.00 per Month or $96.00 per year)
  Retired Affiliate ( $2.50 per month or 30.00 per year)

First Name:
Last Name:
Home Address:
City: State: Zip:
Social Security Number:

Chapter/Employer: Date of Retirement:
Date Joined Local 535:

Home Phone:

E-Mail:

Retired members and retired affiliates are asked to pay dues in advance-either annually or quarterly.

Please send your your dues check payable to "SEIU Local 535" to:
Accounts Receivable, SEIU Local 535, 447 29th Street St. Oakland, CA 94609.

For more information contact, Pat Morones at 510-352-9622.