If you are no longer in the union, or are taking a leave of absence, please provide the following information so we can send you an official withdrawal card.

[contact-form to=’[email protected]’ subject=’Withdrawal Card Request’][contact-field label=’Name’ type=’name’ required=’1’/][contact-field label=’Employer’ type=’text’/][contact-field label=’Date of birth (mm/dd/yyyy)’ type=’text’/][contact-field label=’Last 4 digits of SSN’ type=’text’ required=’1’/][contact-field label=’Address, City, State, Zip’ type=’text’/][contact-field label=’Phone’ type=’text’/][contact-field label=’Last date of employment (mm/dd/yyyyy)’ type=’text’/][contact-field label=’Return date, if applicable (mm/dd/yyyy)’ type=’text’/][/contact-form]

Please note that any submission using this form may or may not reach its intended recipient and shall not be considered “service” of any legal document in any legal form or venue within the United States.