CCWU Commitment Card

By coming together statewide, community clinic workers can build a union with the power to improve our workplaces and the care we provide to our patients.

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Contact Information

First Name Last Name

Street Address (Optional)

Postal Code City State

Email Mobile Phone

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 787753 to stop receiving messages. Text HELP to 787753 for more information.

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(Optional)

Employer Information

Job Title Clinic Name

I am retired

Clinic Address

Clinic City (Optional)

Commitment

I COMMIT TO JOIN COMMUNITY CLINIC WORKERS UNITED and take action to improve our jobs and ensure the clinics we work in provide the best care for our communities.

I commit

I commit to: (Optional)

Talking to my coworkers

Attending a Meeting

Gathering petition signatures

Talk to elected official

Signature