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Updated: Dec. 17 (17:14)
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Withdrawal Card Request Form

If you become unemployed you may request a withdrawal card.  A withdrawal card alleviates you from your monthly dues obligation.  To be eligible for a withdrawal card a member must have paid to the Union all dues and other financial obligations as a member, including dues for the month in which the withdrawal card is effective.  There may be a maximum charge of fifty cents (50¢) to any member issued a withdrawal card.

First Name:
Last Name:
Address:
City, State, Zip:
Phone (+ Area Code):
Email Address:
Last Day Of Work:
Employer:
Last 4 Digits Of SSN:
   
  Termination/Resignation 
Reason For Withdrawal Retirement          Layoff
  Comp/Disability   Leave of Absence
 

 


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December 17, 2017
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