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Membership Application

SEIU Healthcare Minnesota & Iowa Retirees Committee

To join the SEIU Healthcare Minnesota & Iowa Retirees Committee, please complete this membership application.

Your monthly membership fee will be deducted from your retirement check.

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Contact Information

First Name Last Name

Street Address (Optional)

Postal Code City State

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Additional Information

Date of Retirement (Optional)

Last four SS # (Optional)

Authorization and Membership Application

Yes, I wish to join the SEIU Healthcare Minnesota Retirees Committee!

I hereby authorize the deduction of $5.00 per month from my monthly pension check to cover my membership dues to SEIU Healthcare Minnesota & Iowa.

The dues amount may change if authorized in accordance with the SEIU Healthcare Minnesota & Iowa Constitution. If this happens, I authorize the Union to initiate a recurring, automatic funds transfer in the new dues amount when notified by the Union in writing of the new amount and with at least ten (10) days' notice before the next funds transfer date. This authorization shall continue until canceled by me in writing via U.S. mail to the union. Deductions are non-refundable.

Membership dues and contributions to the SEIU Healthcare Minnesota & Iowa are not tax-deductible as charitable contributions.

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