IATSE Local 22

SERF Request Form

S.E.R.F Assistance Request Form

First Name:
*

Last Name:
*

Address:
*

City, State:
*, *

Postal Code:
* -

Phone:

E-Mail Address:
*

Dollar Amount Requested:
*

Reason for the request:
*

Please provide all supporting documents such as a doctor’s letter, medical diagnosis, death certificate, or unpaid bill(s), or unpaid utility bill(s) etc. To attach form use the botton located in the upper left hand coner

* Required Fields

IATSE Local 22

1810 Hamlin St. NE
Washington, DC 20018
202-269-0212