MPO Application

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Apply to become a Member Political Organizer

You can apply to become an MPO by submitting the electronic form below, or by printing this form which you can return by mail. Be sure to return the form or apply online by the June 2 deadline!

If you choose the printed form, please mail to the Director of Member Programs and Participation, SEIU Healthcare 775NW, 33615 First Way S., Ste A, Federal Way, WA 98003.



Member Political Organizer application

Please fill out all form items and submit!

Name

Title
First Name
MI
Last Name
Suffix
Address

- ###
- ###
####  
 

@

Active
Leave of Absence
Retired
Laid off
Other (explain in notes below)

 

 

Please check all that apply.

Steward or Delegate
Member Organizer
Bargaining Team
Executive Board or Officer
Committee Member or other (describe in notes)

Yes
No

 

Yes
No

Yes
No

Yes
No

 

Microsoft Word
Excel

Yes
No

  *

Yes

Yes

Please "sign" the form by typing your name here.

 *