Sick Bank - Open Enrollment

Local 641

TO: AFSCME Local 641 Members

FROM: Kevin Mello, President

DATE: September 4, 2024

RE: Open Enrollment - Sick Leave Bank Donation Form*

In order to participate in the Sick Leave Bank for this year, this application must be submitted to Local 641 Recording Secretary, Gina Brites (PPS, PRAB Rm. 220), no later than October 5, 2024.

• If you are already a sick bank member, you do not need to fill out/submit this form! Donating to the Sick Leave Bank does not affect your Sick Leave Incentive.

As an AFSCME Local 641 member, in good standing, I wish to join and donate one (1) day to the Sick Leave Bank:

NAME (Please print legibly):

SIGNATURE:

DEPARTMENT:

SCHOOL: