CSEA Membership Contact Information

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please fill out this form below. This will allow us to better communicate with you. The union takes your personal information seriously and will not sell or distribute your information to any third party vendor or company. First and last name fields are mandatory to ensure you are a member.

Please tell us if any of the following pertain to you. *

I changed my email address.

I moved and have a new address.

I changed my name.

I no longer have a home phone.

I added or changed my cell phone number.

I haven't received the CSEA News and just want to verify my information.

I've added my work email

Other:

Required

First Name *

Last Name *

Home Email Address

Work Email Address

Home Address

Home Address 2 (Example: Apt #)

City

State

Zip Code

Home Phone Number

Cell Phone Number

I want to receive important text messages.

Text messages will be rare - but could be useful in certain situations.

Yes

Would you like to receive a digital version of the Monthly CSEA News instead of the paper version?

Yes, please send me a digital copy of the CSEA News to my home email address.

No, I prefer to continue receiving the CSEA News via USPS.

Clear selection

Other Information

Please enter additional information that we may need.

Disclaimer: By typing your name below, you are electronically signing your name to certify that all information is true and correct to the best of your knowledge. *

Safe Sender

Please ensure that csea760.com is added to your Safe Sender folder of your email provider. This will help eliminate the chances of important emails being flagged as spam.
By providing my phone number, I understand that CSEA SEIU Local 2001 may use automated calling technology and/or text message me on my cellular phone on a periodic basis. CSEA SEIU Local 2001 will never charge for text message alerts. Carrier message and data rates may apply to such alerts. Text STOP to any messages to stop receiving messages.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Connecticut State Employee Association. Report Abuse

Forms