New Membership Form

By joining together in a union, SEIU Healthcare 1199NW members speak with a united voice for quality healthcare and good jobs.

Be a part of the movement for quality care for our community. Fill out this form to join.

 

Step 1 of 2

  • Date Format: MM slash DD slash YYYY
  • ‡ By providing my phone number, I understand that SEIU and its locals and affiliates may use automated calling technologies and/or text message me on my cellular phone on a periodic basis. SEIU Healthcare 1199NW and SEIU will never charge for text message alerts. Carrier message and data rates may apply to such alerts. Text STOP to 787753 to stop receiving messages. Text HELP to 787753 for more information.


  • Healthcare Workers' Support Agreement



  • Employer Deduction Agreement

  • Hold Politicians Accountable

  • Because decisions made by politicians in Olympia and Washington D.C. affect healthcare funding and our jobs, SEIU members get involved to hold politicians accountable on our issues. Contributions to the SEIU Committee On Political Education (COPE) are used to support elected officials who are committed to improving healthcare.
    per pay period to be forwarded to SEIU Healthcare 1199NW.

    Contributions or gifts to SEIU COPE are not tax deductible as charitable contributions.
  • This authorization is made voluntarily based on my specific understanding that (1) I am not required to sign this form or make voluntary COPE contributions as a condition of my employment by my employer or membership in the union; (2) I may refuse to contribute without any reprisal; (3) I am a U.S. citizen or lawful Permanent Resident of the U.S. and a union member or executive/administrative staff member; (4) The amounts on this form are merely a suggestion, and I may contribute more or less by this or some other means without fear of favor or disadvantage from the union or my employer; (5) SEIU COPE uses the money it receives for political purposes, including but not limited to addressing political issues of public importance and contributing to and spending money in connection with federal, state and local elections and addressing political issues of public importance. This authorization shall remain in effect until revoked by me in writing via U.S. mail to SEIU Healthcare 1199NW.

*Dues are 1.8 percent of your pay, with a cap of $90/month.

New Membership Form