Death in a Member's Family

September 4, 2008 - 10:32am — Martin Ritter

Report a death in a CIUW member's family so we can send an appropriate expression of sympathy.

Name of Member: *

The first and last name of the member who has experienced a death in the family.

Street Address:

The street address of the member, if known

City, STate, ZIP:

Any or all of the member's city, state, and ZIP code if known

Name of Deceased Family Member:

Relationship:

Relationship of the deceased to the CIUW member

Date of Funeral: *

If unknown, use today's date and indicate "Funeral Date Unknown" below

Additional Information:

Please add any details, such as the the obituary date and location (newspaper or url), memorial requests, etc.

Connecticut Independent Utility Workers, Local 12924