OPEIU Local 8 Hardship Fund Donation Form

By completing this form and clicking “I accept” below, I, the undersigned, hereby authorize my Employer to deduct the amount designated per month from my paycheck and forward this amount to the Secretary-Treasurer of OPEIU Local 8, AFL-CIO, by the last day of each month in accordance with my Collective Bargaining Agreement. This authorization is signed voluntarily and with the understanding the OPEIU Local 8 will use this money to assist fellow members who are experiencing an immediate, severe and temporary financial situation due to an emergency. The remittance check will be made payable to OPEIU Local 8 Hardship Fund.

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Cell Phone Number*

Please enter a valid phone number.

* By providing my cell phone number ad clicking "I consent", I authorize OPEIU Local 8 and its affiliates to use automated calling technologies and/or text message me on my cell phone on a periodic basis. Carrier message and data rates may apply to such texts.**

I acceptI reject

Personal Email*

example@example.com

Monthly Contribution Amount*

Employer*

Date*

Date

Signature*