Withdrawal Card
Use this form to stop dues from being taken out of your paycheck temporarily.

Please note the following:
- In order to get a withdrawal card you have to not work for a whole calendar month.
- If you work one day in a month, Union Dues are owed for that month.
- Dues must be current before a withdrawal card can be issued.  (Union Dues are not prorated)
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First Name *
Last Name *
Email Address - Please provide your Personal E-mail Address *
DO NOT USE YOUR WORK EMAIL ADDRESSS
Phone Number *
Please use format 111-222-3333
What company do you work for? *
Street Address *
Provide your full address including any APT #, City, State and Zip
Last 4 of Social *
Last Day Working *
MM
/
DD
/
YYYY
What is the reason you want to stop dues? *
Electronic Verification *
By checking the "I certify" box below: I affirm that I am the member named above and I wish to temporarily suspend the withdrawal of dues.
Required
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