Steward Jacket Order Form

If you have served for at least five continuous years as a shop steward with SEIU Local 503, you are eligible to receive a Super Steward Jacket.

Name

Title

First Name *

Last Name *

Suffix

Worksite or Agency

* 'Worksite or Agency' is required

Length of continuous steward service

* 'Length of continuous steward service' is required

Home Phone

- ###

####

Work Phone

- ###

#### *

Home e-mail

Jacket Size

Name to appear on jacket

* 'Name to appear on jacket' is required