NATIONAL AFRICAN AMERICAN CAUCUS
(AFRAM) SEIU

2009 ONLINE MEMBERSHIP APPLICATION & SURVEY

Full Name
Home Address
City/State/Zip Code
Home Phone
Cell Phone
Work Phone
E-mail Address
Local Union
How long have your been a member/staff of SEIU? Are you a Member Organizer? (MO) Yes No Member Political Organizer? (MPO) Yes No Are you interested in becoming a (MO)? Yes No (MPO) Yes No Are you a staff person? Yes No Are you an elected officer? Yes No SEIU Region 2009 Membership Dues Membership Dues for one year: $20.00 Membership Dues for two years: $40.00 Note: After submitting your membership application, you will be redirected to the online payment center. A processing fee of $2.00 will be added to your dues.