OPEN ENROLLMENT FORM FOR SEIU/NGO 2014-12015

DEADLINE: July 1, 2014

www.seiuNGO.com
The NGO (Non Germane Objector) information is mailed by SEIU Local 1000 to Non-
Members once a year. Non Germane Objector Information can easily be verified by
SEIU Local 1000. Phone Number: (866) 471-7348.

ADVANTAGE of Becoming a Non Germane Objector 2014 2015:
1- REDUCE YOUR MONTHLY DUES by 34%
2- STILL BE ENTITLED TO FAIR & IMPARTIAL REPRESENTATION

Effective July 1, 2014 through June 30, 2015 (the "2014-15 Fee Payer Year), SEIU LOCAL 1000
will charge fee payers who object to expenditures not germane to collective bargaining a fee of
no more than 66.44% of regular membership dues for that salary level. In order to obtain this
reduced amount, you must send an objection letter to SEIU LOCAL 1000's Membership
Processing Center. Complete all 6 items is a requirement.

OBJECTION LETTER TO SEIU LOCAL 1000s MEMBERSHIP PROCESSING CENTER
SEIU Local 1000 Membership Cancellation & Non-Germane Objector (NGO)
I am submitting this form to cancel my SEIU Local 1000 membership
I am filing for Non-Germane Objector
I object the use of my fees for activities NOT related to collective bargaining


________________________________________________________________
1- SIGNATURE DATE

________________________________________________________________
2- Print First/M.I./Last Name

3- Street ADDRESS__________________________________________________

4- CITY/State/ZIP: __________________________________________________

6- Department: _____________________________

5- Agency/Bargaining Unit see: www.seiuNGO.com ________
6- Last 4 digits of your SSN (for identification) ___________

CSEA/SEIU Membership 1108 O Street, Ste 415 Sacramento, CA 95814
Objector letter must be received by July 1 2014.