Financial Hardship Dues Waiver

FINANCIAL HARDSHIP DUES WAIVER

Citizens Coal Council doesn't want financial constraints to be an obstacle to membership. If you are unable to afford the $25 minimum membership dues, please fill out and submit a Financial Hardship Dues Waiver form. We will carefully review your submission and notify you of our decision.

Financial Hardship Dues Waivers are only available to individuals, as Citizens Coal Council is not accepting member organizations at this time.

A full or partial waiver is available to new and existing members whose circumstances have resulted in significant financial hardship, including, but not limited to, layoffs or job loss, temporary or permanent disability, parental leave, medical illness or other circumstances outside of his/her control.

All information provided in this form will be used strictly for the purpose of determining eligibility for a financial hardship dues waiver, and will remain confidential.

* Indicates required field

Name *

First

Last

Address *

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City

State

Zip Code

Country

Phone Number *

Email *

Please describe your financial situation and reason for request for a financial dues waiver. Citizens Coal Council may request additional information in order to review your request.

Financial circumstances *

Please confirm: *

YES, I understand that submitting this form is no guarantee that a Financial Hardship Dues Waiver will be granted. I hereby declare that the above information is true and complete to the best of my knowledge.

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