Phone Bank and Labor Walk Voucher Form - Health Professionals & Allied Employees

Phone Bank and Labor Walk Voucher Form

    Name

    Street Adress

    City

    State

    Zip code

    Is this a new address?

    Phone Number

    Email

    Are you a member of HPAE?

    If yes, which HPAE local/facility?

    Please select which activity you participated in:

    Location

    Date

    Shift Completed (if you completed more than one shift you will need to complete this form for each shift)

    Amount owed for this shift

    Disclaimer: You may be asked to complete a 1099 tax form if you exceed $600 in earnings in this calendar year.