CWA Members' Relief Fund Striker Certification Form
Questions marked by * are required.
First and Last Name *
Street Address *
City and State *
Full Social Security Number (For W2 Purposes) *
Phone Main *
Bargaining Unit: *
Local Steward's Name
Certification and Electronic Signature *
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.