Verification and Release Form

Verification & Release Form

I verify that the statements provided are true and correct, and that I am at least 18 years of age. I give 32BJ Service Employees International Union and its affiliated organizations (the "Union") permission to use my name, photograph(s), statements and/or video in Union publications, websites, mobile applications, flyers, advertisements, and videos.

First Name

Last Name

Employer

Work Address

Email*

*By providing your email address, you are allowing us to email you.

Phone/Mobile**

**By ticking yes, you are allowing us to call you, including by autodialer, and text you. Local 32BJ will never charge you for text message alerts, but carrier message and data rates may apply. Text STOP to 787753 to unsubscribe and HELP for more info. Periodic updates, up to 5 per month.

Yes! Send me text messages or calls to this phone.

No, do not send text messages or calls to this phone.

If you need to submit photos, videos, files or statements, please do so below.

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Statements

Verification and Release Form

Verification & Release Form

SEIU 32BJ

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