WITHDRAWAL FORM LINK - UFCW Local 1776



WITHDRAWAL FORM LINK

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WITHDRAWAL CARD

It is necessary to obtain a withdrawal card from your local Union when you leave the packing or retail field to avoid payment of reinstatement fees upon returning to retail employment.

To obtain a withdrawal card, make a written request to your local union office, giving your name, address and reason for leaving. The withdrawal card will be issued at no cost. The only requirement being that your initiation fee be fully paid and your dues must be paid for the month in which you request the withdrawal card.

The withdrawal card is good indefinitely and allows you to become a member of any local Union affiliated with the United Food & Commercial Workers International Union without payment of any additional fee.

WITHDRAWAL CARD REQUEST FORM

Upon termination of employment with your company, this form may be used for obtaining a withdrawal card. Make certain that you complete the form in its entirety and return to 345 Southpointe Blvd., Suite 300, Canonsburg, PA 15317 ATTN: Julie Gigliotti

Name S.S. #

Address

City State Zip

Telephone Number

Employer

Last Day Worked

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