Member Stories Spring 2007

What's your story photos

Have you, someone you love
or a patient you cared for:

* Suffered financial hardship because of excessive healthcare costs?

* Been denied important medical care, or been unable
to afford it?

* Lost your coverage at a critical time?

* Have healthcare costs damaged your credit, housing
or employment?


Fill in the form below and tell your story. * indicates required fields Your story here....

First name	*
Last name	*
Email address	*
Address 1
Address 2
City
State
Zip code
Phone (include area code)	*
Cell phone (include area code)
Employer

Yes! I'll fight to change healthcare by:
Attending lobby days in Sacramento	Joining COPE
Calling my legislator	Writing letters to elected leaders
Receiving campaign updates	Educating my co-workers
Becoming an E-Activist	Attending town hall meetings
In consideration of value received, I hereby grant to Service Employees International Union-United Healthcare Workers West and its legal representatives and assignees, permission to copyright, sell, publish, post on the web and or use quotes or photographic portraits or pictures, video of me or in which I am included, in whole or part, for advertising, trade or any other lawful purpose whatsoever. I hereby waive any right that I may have to inspect or approve the finished product or products or advertising or web publishing or printed matter that may be used in connection with this picture/video/quote or the use to which it may be applied. I hereby release, discharge and agree to hold harmless the above from any liability by virtue of any blurring, distortion, alteration, optical illusion or use in composite form, as well as any publication. I hereby warrant that I have every right to contract in my own name in the above regard.<br /><br />Healthcare stories are being collected to share with elected leaders and members of the media. By submitting this form with your story you agree to allow SEIU United Healthcare Workers-West to share your story with decision makers and the media to advance the campaign for healthcare reform. I have read the above and give my approval. * If you would rather that your story is used anonymously, please check this box. Please still provide your information in the fields above.

Yes! I'll fight to change healthcare by: