Resident & Fellow Physician Union Membership Application
To apply for membership please complete the form. If you have questions, please email email@example.com. Dues are 0.5% of your PGY salary, deducted from your bi-monthly paychecks.
What is your residency/fellowship status?
I am CURRENTLY a resident/fellow at UW
I START residency/fellowship at UW in the 21-22 academic year
UW Employee ID (if you don't have yet, you can leave blank)
Example: ID# 818000000
hereby authorize my employer, The University of Washington to deduct from my wages and pay the RFPU an amount equal to the dues that I am responsible to pay to the RFPU in order to secure and maintain my membership in RFPU. This authorization shall be irrevocable for a period of one year or until the termination of the collective bargaining agreement between my employer and the RFPU, whichever occurs sooner. This authorization will be automatically renewed at the end of this period for successive periods of one year unless I give my employer written notice revoking this authorization not more than 25 days and not less than 10 days prior to the end of each one-year period (or prior to the expiration of the collective bargaining agreement if that occurs sooner), even if I have resigned my membership in the RFPU. I would like to be a member of the Resident Fellow Physician Union - NW and agree to pay the associated membership dues. I recognize the need for a strong union and believe everyone represented by our union should pay their fair share to support our union’s activities. I recognize that my authorization of dues deductions, and the continuation of such authorization from one year to the next, is voluntary and not a condition of my employment.
Date Picker Icon
Should be Empty:
Now create your own JotForm - It's free!
Create your own JotForm