Phone: 949-486-3631
3631 Member COVID-19 Donation Request

3631 Member COVID-19 Donation Request

Members are asked not to submit your form until you return back to work.
Submitting early will create further delays in processing.

All fields are required below, except additional notes

First Name:
Last Name:
Employee ID#: 
Contact Phone Number:
Contact Email Address:
Full Mailing Address: (including city, state & zip)

Are you a dues paying member of the Orange County Professional Firefighters Association, 
IAFF Local 3631? 

Were you placed on a COVID-19 related work-restriction by the OCFA?

(Format all dates below:  mm/dd/yyyy)
First day of work restriction:    

Last day of work restriction:   

First day back at work:            

Were you tested for COVID-19 by the OCFA?

If yes, was your test result or if no, choose N/A:

Additional note: (limit to 500 characters)

Enter the text shown in the image above.

Contact Info
IAFF Local 3631
1342 Bell Ave #3A
Tustin, CA 92780

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