Picket Line Registration Form

Picket Line Registration Form

In the event of a legal strike, every member who is prepared to legally picket must complete and submit this form prior to the start of the strike.

As a reminder, to qualify for tax-free picket pay, members must picket wearing a UFCW bib:
24 hours per week, if you are a full-time worker (FT status).
20 hours per week, if you are a part-time worker (PT status).

If needed, a list of commonly asked strike and picket line questions is available here.

First Name *

Last Name *

Email *

Primary Phone Number *

Phone Type *

Emergency Contact *

Emergency Contact's Phone Number *

Employment Status *

Workplace *

The picket line will be in place for the duration of your workplace’s regular business hours.
Please select which 4-hour blocks you will be available each week. **You can select as many blocks as you wish**, we will do our best to accommodate your availability.

Any comments or accommodation requirements we should be aware of?

Comments / Requirements

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