SEIU Healthcare 775NW | Online Order Form

Online Order Form

Contracts, Contract Highlights, Membership Forms, Benefit Summaries, Voter Registration Forms

Most orders take 3-5 business days to process and will be shipped via UPS. (Individual contracts may be sent via the US Postal System.)

If you do not receive your materials within 7 business days, please call our Member Resource Center toll-free at 1 (866) 371-3200.

Email: *

First Name: *

Last Name: *

Address: *

City: *

State/Region/Province: *

Zip / Postal Code: *

Phone: *

Affiliation: *

Use the drop down box to pick your employer/contract name. This will ensure we send you the right contract and ensure we pre-print the correct Employer on any Membership Forms you request.

(For example, if you work for DSHS, are an IP or serve IPs, then pick the first item on the list, "State of Washington - IPs").

Employer/Contract Name Drop Down: *

In the boxes below, please fill in the number of each item you want.

Membership Forms

Minimum Order for English = 200; All Other Languages = 100

English:

Spanish:

Russian:

Korean:

Contracts

Full Collective Bargaining Agreement:

Highlights:

IP Benefit Summaries

Minimum Order = 100

Health/Vision:

Dental:

IP Health Insurance Enrollment Form:

Voter Registration Forms

Minimum Order = 100

Washington:

Montana:

Comments/Questions:

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