Chapter 1 Makes Us Stronger Together

Continue helping contribute to a stronger voice in our communities.

Contact Information

First Name Last Name

Street Address

Postal Code City State/Province

Personal Email Address Phone (Home) Phone (Cell) (Optional)

By providing my phone number, I understand the State Employees' Association, the Service Employees International Union, and its affiliates may use automated calling technologies and/or text messaging 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. By providing my email address, I agree to receive periodic e-mails.

(Optional)

Additional Information

What Department or Chapter where you last worked?

Associate Member Name (If Any) (Optional)

Associate Member Cell (If Different) (Optional)

Associate Member Email (If Different) (Optional)

Today's Date

Do You have a Seasonal Address?

Yes (Please fill out the address in the next question)

No (Skip the next question)

What is your Seasonal Address (If you have one) and what dates are you at this address? (Optional)

Do You Have a Printer?

Yes

MEMBERSHIP AUTHORIZATION: Yes! I want to join with my fellow retirees and become a member of SEA/SEIU Local 1984 ("SEA") Chapter 1. I hereby request and voluntarily accept membership in SEA and I agree to abide by its Constitution and Bylaws and by the Service Employees International Union Constitution and Bylaws. By signing this card, I certify that I retired from State service as a member in good standing of the SEA. I also certifiy that dues in the amount of $6 are due annually to the Assocation and it is my responsibility to provide said payment to the Association.

Please return form and check to: SEA SEIU Local 1984 207 North Main Street Concord, NH 03301

For additional information, contact the Chapter 1 Membership Secretary: Avis Crane @ (603) 344-2912 -- or -- avislcrane@gmail.com

Signature