CWA - Local 7803 | Relief Fund Striker Certification

CWA MEMBERS' RELIEF FUND STRIKER CERTIFICATION FORM

WARNING: CWA Local 7803 represented employees only. Unauthorized use prohibited. Submitting this form records your IP address.

Please fill out all required fields. Once submitted, this form will be automatically forwarded to the Local. Please contact the Local or your Steward for more information.

* indicates required entry

*Bargaining Unit
*Name
*Address (Line 1)
*Address (Line 2)
Last 4 Digits Social Security #
*Phone (home)
Phone (cell)
Email Address:
*Employer
*Worksite
Steward's Name:
*Please read and check button to authorize a "signed & dated" CWA Members' Relief Fund Striker Certification Form.	I certify that I am eligible to receive strike benefits under the rules of the Members Relief Fund. I understand that if I am found ineligible under the rules, I will return any payments I am not entitled to.