Displaced Member SEIU Local 2015

As a former active member of a bargaining unit represented by SEIU Local 2015, you can opt to become a Displaced Member and gain access to exclusive benefits and privileges, including:

Dental and vision insurance coverage
Life Insurance with accidental death and dismemberment
Discounts on movie and theme park tickets, cell phone service, restaurants, vacation packages, and more products and services
The chance to stand with workers across California and nationwide to fight for better wages, health care benefits, training opportunities, work hours, and more!

You are eligible to apply to become a Displaced Member of SEIU Local 2015 if you have been an active regular member in the past but HAVE NOT had an IHSS client or worked in a bargaining unit represented by SEIU Local 2015 for 6 months or longer.

Not sure you’re in the right place? We’ve got your back! Call the MAC at 1-855-810-2015. To read a full explanation of SEIU Local 2015 membership levels, please click here.

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Join Today! Complete the Application Form Below.

Rolodex Number

Email*

First Name*

Last Name*

Street Address*

City*

State*

Zip Code*

Cell Phone

Your Preferred Language*

By including your mobile number you are authorizing SEIU Local 2015 and its affiliates, using various automated technologies, to call you and send text alerts to you occasionally. We will never charge you for text message alerts but carrier message fees and data rates may apply.

Your Former Employer Represented by SEIU Local 2015*

IHSS

Nursing Home

Homecare Private Agency

Assisted Living Facility

Monthly Membership Payment*

$15.50 per month

Credit Card Information

Please note, if you ever need to update your billing information, please contact the MAC at 1-855-810-2015.

Billing Information*

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number

Expiration Date Month Year

Security Code Cardholder Name

First Name Billing*

Last Name Billing*

Billing Address*

Billing City*

Billing State*

Billing Zip*

Billing Country*

Billing Phone Number*

Billing Email*

Membership Terms: I hereby pledge my support for SEIU Local 2015, and all of its members, in their fight for Dignity for all long term care providers, their clients, and all who call California home.

I understand that as a Displaced Member of SEIU Local 2015, I may be eligible to participate in certain benefit programs of Local 2015, but I am not entitled to representation by Local 2015 with respect to terms and conditions of employment. I hereby certify that I am not currently employed in any bargaining unit for which Local 2015 is the recognized bargaining agent for matters relating to wages, hours and other terms and conditions of employment. I understand that if I regain employment in a bargaining unit represented by Local 2015, the membership card for Regular Membership I previously signed will be reactivated and I will automatically return to being a full member of Local 2015.

I also hereby affirm that I am not an employer, or an agent of any employer, of any employee(s) represented by Local 2015.

Do you understand and agree to the membership terms?*

Yes

Your Full Name*

Today's Date*

Dues Authorization Terms: I authorize SEIU Local 2015 to debit the credit card account indicated in this web form for the noted amount on a monthly basis. This payment is for SEIU Local 2015 Displaced Membership dues. I understand that this authorization will remain in effect until I cancel by calling SEIU Local 2015 at 1-855-810-2015. I agree to notify SEIU Local 2015 of any changes in my account information or termination of this authorization at least 15 days prior to the next billing date. If the payment date falls on a weekend or holiday, I understand that the payment may be executed on the next business day. I certify that I am an authorized user of this credit card and that I will not dispute the payment with my credit card company, so long as the transaction corresponds to the terms indicated in this web form.

Contributions or gifts to SEIU Local 2015 are not tax deductible as charitable contributions. However, they may be tax deductible as ordinary and necessary business expenses.

Do you understand and agree to the dues authorization terms?*

Yes

Your Full Name*

Today's Date*

COPE Committee on Political Education (C.O.P.E.) Authorization

Yes, I want to contribute the following amount to SEIU COPE:

$20 per month

$15 per month

$10 per month

Choose not to contribute at this time

COPE Authorization Terms: Yes! I want to hold politicians accountable to working families and I know we can only do that if we stand together. I hereby authorize SEIU Local 2015 to deduct the indicated amount per month as a contribution to SEIU Committee on Political Education (“SEIU COPE”). My signature shows that I agree with the terms below.

This authorization is made voluntarily based on my specific understanding that: (1) I am not required to sign this form or make voluntary contributions to SEIU COPE as a condition of my employment or membership in the union; (2) I may refuse to contribute without reprisal; (3) Under law, only union members and executive/administrative staff who are U.S. Citizens or lawful permanent residents are eligible to contribute to COPE; (4) the contribution amounts on this form are merely suggestions, and I may contribute more or less by this or other means without fear or disadvantage from SEIU Local 2015; (5) SEIU COPE uses the money it receives for political purposes – including, but not limited to, making contributions to and expenditures on behalf of candidates for federal, state, and local offices – and addressing political issues of public importance. This authorization shall remain in effect until revoked by me in writing to SEIU via U.S. mail or other permitted method.

Contributions or gifts to SEIU COPE are not tax deductible as charitable contributions.

Do you understand and agree to the cope authorization terms?*

Yes

Your Full Name*

Today's Date*

By clicking join, you accept that your printed name, IP address and the date and time will be used as your digital signature.

Name

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