Online order form Question Title * 1. Contact information Name * Address * Address 2 City/Town * State/Province * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code * Country Email Address * Phone Number * Question Title * 2. Affiliation: SEIU 775 member Washington State DSHS Private Sector Home Care Agency Nursing Home SEIU 775 staff Question Title * 3. Please use the dropdown menu to select 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"). No specific employer (for members or staff only) State of Washington (IPs, DSHS, AAAs) Addus Clarkston Addus Colfax Addus Colville Addus Hayden Addus Kalispell Addus Lewiston Addus Libby Addus Longview Addus Moses Lake Addus Okanogan Addus Ontario Addus Pasco Addus Republic Addus Seattle Addus Spokane Addus Tacoma Addus Vancouver Addus Walla Walla Addus Wenatchee Addus Yakima Adult Day Health Amicable Avalon Pullman Avamere Heritage Avamere Pacific Ridge AWARE CCS Aberdeen CCS Bellingham CCS Bremerton CCS Chehalis CCS Everett CCS Kent CCS Longview/Kelso CCS Olympia CCS Port Angeles CCS Raymond CCS Seattle CCS Shelton CCS Tacoma CCS Vancouver CCS Wenatchee Chesterfield Chewelah Chesterfield Everett Chesterfield Kent Chesterfield Kirkland Chesterfield Longview Chesterfield Seattle Chesterfield Spokane Chesterfield Stevenson Chesterfield Tacoma Chesterfield Tri-Cities Chesterfield Vancouver Chesterfield Walla Walla Chesterfield Yakima Concerned Citizens Forks Concerned Citizens Port Angeles Concerned Citizens Port Hadlock Concerned Citizens Port Townsend Concerto Senior Care EmpRes Americana EmpRes Bremerton EmpRes Enumclaw EmpRes Missoula EmpRes North Cascades EmpRes Park Royal EmpRes Whitman First Choice In-Home Care Fortis Aldercrest Fortis Fir Lane Fortis North Auburn Fortis Pacific Full Life Care Buchanan Full Life Care Connection Full Life Care Gaffney Full Life Care Homecare Full Life Care Jefferson Terrace Full Life Care North Branch Full Life Care Snohomish Full Life Care South Branch Genesis Ballard HCS Billings HCS Bozeman HCS Dillon HCS Glasgow HCS Hamilton HCS Hardin HCS Lame Deer HCS Miles City HCS Missoula HCS Roundup HCS Sidney Horizon House KWA Aberdeen KWA Centralia KWA Federal Way KWA Lynnwood KWA Olympia KWA Port Angeles KWA Port Orchard KWA Port Townsend KWA Sequim KWA Shelton KWA Tacoma Libby Care Center Millennia Healthcare King Millennia Healthcare Snohomish Prestige Camas Prestige Clarkston Prestige Grandview Prestige Northcreek Prestige Parkside Prestige Pinewood Prestige Richland Prestige Royal Vista Prestige Sunnyside Prestige Toppenish Providence Mother Joseph Providence Mount Saint Vincent ResCare Aberdeen ResCare Bellevue ResCare Bellingham ResCare Centralia ResCare Everett ResCare Federal Way ResCare Freeland ResCare HCOW Clarkston ResCare HCOW Colville ResCare HCOW Ellensburg ResCare HCOW Grand Coulee ResCare HCOW Moses Lake ResCare HCOW Okanogan ResCare HCOW Spokane ResCare HCOW Sunnyside ResCare HCOW Tri-Cities ResCare HCOW Walla Walla ResCare HCOW Wenatchee ResCare HCOW Yakima ResCare Kelly Seattle North ResCare Kelso ResCare Kent ResCare Lakewood ResCare Lynnwood ResCare Oak Harbor ResCare Olympia ResCare Puyallup ResCare Seattle ResCare Sequim ResCare Silverdale ResCare Tacoma ResCare Vancouver ResCare Residential Talbot Center Vancouver Specialty Vashon Community Care Center Question Title * 4. How many NEO packets do you need?: New Employee Packets (WA DSHS & Individual Providers Only). Each packet contains an English membership form, voter registration form, and full CBA for the State of WA. Question Title * 5. Membership Forms Please indicate the number of Membership Forms you need. If you are DSHS or an IP, these are **separate** from the membership forms included in NEO packets. English Spanish Russian Korean Question Title * 6. How many copies of the Full Collective Bargaining Agreement do you want? Question Title * 7. How many copies of the Highlights/Summary do you want? (DSHS only) Question Title * 8. Comments/questions: Submit order