NATIONAL AFRICAN AMERICAN CAUCUS (AFRAM) SEIU
DUES YEAR 2008
MEMBERSHIP APPLICATION & SURVEY

 
NAME:  _________________________________________________________________
 
HOME ADDRESS:  _______________________________________________________
 
CITY/STATE/ZIP:  ________________________________________________________
 
PHONE (Home):  ________________________  E-MAIL__________________________
 
Local Union: ____________________________      Are You A Retired Member? __________

 
Are you a Member Organizer? (MO) _________    Member Political Organizer? (MPO) _________
 
Are you interested in becoming a (MO)? __________       or        (MPO)? __________
 
Are you a staff member? __________           Are you an elected officer? __________



REGION:      WEST       CENTRAL      SOUTH         EAST    (circle one)

 

                         ANNUAL MEMBERSHIP DUES RATE: $20.00
 

                              (   )   PAY MEMBERSHIP DUES FOR TWO YEARS:  $20.00

                              (   )   PAY MEMBERSHIP DUES FOR TWO YEARS:  $40.00

                              (   )   I WISH TO MAKE AN ADDITIONAL CONTRIBUTION $_________


 

MAKE CHECKS PAYABLE TO:   AFRAM SEIU

MAIL TO:   1673 Columbia Rd. NW Suite 100
     Washington, DC  20009
 

VISIT OUR WEBSITE: WWW.AFRAM-SEIU.ORG