CWU 2022 Flood Victims and Volunteers Member Assistance Fund

Please complete the form below and a Branch Official will contact you shortly.

Your full name *

Title

First Name

Last Name

Your member number

You can find this on your membership card or welcome letter. If you are unsure, please respond "unsure".

Your best contact phone number *

Your email address *

Email

Your home address *

Address Line 1

Address Line 2

City

State

Zip Code

Your workplace *

What funding assistance are you seeking? *

You may select more than one response, if applicable.

If you are seeking a volunteer assistance payment, how has your absence from employment been treated?

You may select more than one response, if applicable.

If you are seeking a volunteer assistance payment, which organisation do you belong to or are you assisting?

Any additional important information and/or comments pertaining to your request