Associate Membership Application

Please Note: Associate Membership is intended for members of the Community who are not dues paying, represented members of SEIU 721. If you are already a SEIU 721 Member or Fee Payer Click here to fill out your membership card!

As an employee of LA County when you sign up for Associate Membership you get access to all of the benefits that SEIU 721 members working for LA County enjoy. As an Associate Member, you’ll enjoy a guaranteed life insurance and accidental death coverage policy. You’ll also be able to access a wide array of benefits that you can voluntarily opt into at a discounted rate, all while supporting investments in the people all across Los Angeles County who rely on the services we provide. For a detailed list of LA County benefits click here.
YES, I wish to join SEIU LOCAL 721 as an ASSOCIATE MEMBER to support its mission to fight for better wages and conditions for workers and their families.
Name*
First Last
Cell Phone
Home Phone
Birthdate*
Month
Day
Year
Personal Email Address*
Home Address
Street Address Address Line 2 City State Zip Code
Employee ID Number*
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Employer
Worksite
Allow Text
- Allow Text
Yes, 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 [any text from us or 721721] to stop receiving messages. Text HELP to 721721 for more information.
Associate Membership Options*
- RANK & FILE MEMBER: $15 a month
- LABOR LEADER: $30 a month
- CHAMPION: $60 a month
I hereby authorize SEIU Local 721 to automatically deduct from my paycheck each month and remit directly to SEIU LOCAL 721 to cover my associate membership dues. This authorization shall continue until canceled by me in writing to SEIU Local 721. Deductions are non-refundable.
Electronic Signature*
I understand this is a legal representation of my signature
Membership dues and contributions to SEIU LOCAL 721 are not tax deductible as charitable contributions.