Political Action Interest Form

Take Action for Political Change

SEIU Local 1 Members: Fill out the form below and we will let you know how you can help build political power for working people.

Check all options that interest you

Calling other members
Talking to co-workers
Traveling to nearby states
Door-to-door voter registration
Joining the mailing list
Organizing my co-workers by becoming a Member Political Organizer

Name

Title

First Name *

Last Name *

Suffix

Address

Address 1

Address 2

City

State / Province / Region

Postal Code

Country

Phone

- ###

#### *

Employer

* 'Employer' is required

Type of work (ex. janitorial or security)

'Type of work (ex. janitorial or security)' is required

Worksite

'Worksite' is required

Shift

'Shift' is required