New Membership Form (Page 1 of 2)

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.

First Name*
Last Name*
Email*
Pronoun (check one):
- she/her
- he/him
- they/them
- ze/hir
- prefer no pronoun/use my name
Race:
Ethnicity
Cell Phone*
Hospital/Clinic/Agency*
Campus / Worksite
Department
Job Title
Today's Date*
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.
Address*
Street Address City State ZIP Code
Healthcare Workers' Support Agreement
Yes, I want to join with my co-workers and become a member of SEIU Healthcare 1199NW. This means I will receive the benefits and abide by the Constitution and Bylaws of both SEIU Healthcare 1199NW and Service Employees International Union (SEIU). I authorize SEIU Healthcare 1199NW as my representative in collective bargaining over wages, benefits, and other terms and conditions of employment with my employer, and as my exclusive representative where authorized by law. I know that membership in the union is voluntary and not a condition of my employment, and that I can decline to join without reprisal.*
- Yes, I authorize the above.
Signature Verification 1*
New Membership Form (Page 1 of 2)
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*Dues are 1.8 percent of your pay, with a cap of $90/month.

Healthcare Workers' Support Agreement