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For Members

1199SEIU Computer Giveaway

Email Collection Form

This form should be used by contest participants to collect information from coworkers. If you would like to enter the contest but have not yet submitted your own information, complete this Contest Signup Form. 

Your Name:
 Please submit the following for each member included in your contest entry. This section should include their information, not yours.
First Name:
Last Name:
Last 4 Digits of Social Security Number:
Address:
City:
State:
Zip:
Email:
 I don't have an email address. Sign me up for a free account with 1199SEIU.
(You will receive login instructions by mail.)
Employer/Institution:
Job Title:
Home Phone:
Cell Phone: