First Name*
Last Name*
Street
City
State/Province
Select a state
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
D.C.
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces (the) Americas
Armed Forces Europe
Armed Forces Pacific
Alberta
British Columbia
Manitoba
Newfoundland
New Brunswick
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Other
Zip/Postal Code
Email*
AFSCME Affiliate*
AK - ASEA, Local 52
AK - PSEA
AR - Council 38
AZ - Council 97
AZ - Fed. of Physicians and Dentists, NUHHCE
CA - Council 36
CA - Council 57
CA - CUHW
CA - EAMWD, Local 1902
CA - Local 206
CA - Local 3299
CA - UAPD, NUHHCE
CA - UCCU, NUHHCE
CA - UNAC/UHCP, NUHHCE
CA - UDWA
CO - Council 76
CT - CT Health Care Assoc., NUHHCE
CT - Council 15
CT - Council 4
DC - Council 20
DC - Council 26
DC - Doctor's Council
DC - Local 1199 Metropolitan DC, NUHHCE
DE - Council 81
FL - Council 79
FL - Fed. of Physicians and Dentists, NUHHCE
GA - Local 1644
HI - HGEA, Local 152
HI - EWC, Local 928
GA - Local 3
HI - UPW, Local 646
IA - Council 61
IL - Council 31
IL - House Staff Assoc. of Chicago, NUHHCE
IN - Council 62
KS - KOSE, Local 300
KY - Council 62
LA - Council 17
MA/ME/NH/VT - Council 93
MD - ACE, Local 2250
MD - AFSCME MD
MD - Council 67
MI - Council 25
MI - MSEA, Local 5
MN - Council 5
MN - Council 65
KS/MO - Council 72
MO - Local 500
MT - Council 9
NE - NAPE, Local 61
NE - NPE, Local 251
NC - Local 77
ND/SD - Council 59
NJ - Council 1
NJ - Council 52
NJ - Council 71
NJ - Council 73
NJ - Local 1199C, NUHHCE
NJ - Local 1199J, NUHHCE
NJ - Local 1199
NM - Council 18
NM - Local 1199NM, NUHHCE
NV - SNEA, Local 4041
NY - CSEA, Local 1000
NY - Council 1707
NY - Council 35
NY - Council 37
NY - Council 66
NY - Council 82
OH - Council 8
OH - OAPSE, Local 4
OH - OCSEA, Local 11
OK - Local 1180
OK - Local 2406
OR - Council 75
PA - Council 13
PA - Council 33
PA - Council 47
PA - Local 1199C, NUHHCE
PA - UCCU, NUHHCE
PA - United Nurses of Pennsylvania
PR - Council 95
RI - Council 94
TX - Council 7
TN - Local 1733
TX - HOPE
TX - Local 59
TX - Local 1550
TX - Local 1624
TX - Local 2399
UT - Local 1004
VA - Council 27
VA - Local 3001
WA - Council 2
WA - Council 28
WI - Council 11
WI - Council 24
WI - Council 40
WI - Council 48
WV - Council 77
None/I don't know
Retiree member
Member at large
Local Number (type "don't know" or "none" if appropriate)