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Get Care Providers (child Care & Adult Foster Care) - Seiu503

BIRTH DATE: MONTH / / DAY YEAR HOME PHONE: HOME E-MAIL: RESIDENCE ADDRESS: (REQUIRED) MAILING ADDRESS: STREET CITY STATE ZIP STREET CITY STATE ZIP Please indicate the type of care you provide: CHILD CARE Child Care Provider # ADULT FOSTER CARE AFC Provider # I desire to be represented by SEIU Local 503, OPEU and hereby designate SEIU Local 503, OPEU as my bargaining agent for all matters pertaining to collective bargaining. I request my e.

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