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Request for a Withdrawal Card

Be sure to request a withdrawal card when being laid off, going on a leave of absence, lengthy medical leave for an on- or off-the-job injury (when exceeding a full calendar month), being called up for military service or terminating your employment.  All fees, including initiation, back dues and/or late fees must be paid before a withdrawal card can be issued.  Your dues must be current (paid through the month in which you take out the withdrawal card) to issue you a withdrawal card.  Please take the time to protect your membership status by calling our office immediately upon your absence from employment.  Failure to call our office to request a withdrawal card may result in you owing additional dues.  If you should ever have any questions regarding your membership status, please call our office at (315) 471-4164, extension 110

When you return to work, it is YOUR responsibility to contact the office at extension 110 and be taken off withdrawal. Failure to do so will put you in arrears.

Full Name:
Address:
Phone Number:
Last Four of SSN:
Employer:
Last Day Worked:
Reason No Longer Working:
Email Address:

Signature:

Use your mouse, finger, or touch device to write your signature.


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Teamsters Local 317
149 Northern Concourse
Syracuse, New York 13212
  315-471-4164

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