Teamsters Local 317

Request for a Withdrawal Card

Please request a withdrawal card if you are a member in good standing, with your dues paid current, who is no longer working at your represented workplace due to quit, discharge, layoff, retirement, or extended leave (in some circumstances). A request does not guarantee that one will be issued to you.

If you do not receive your withdrawal card within two weeks of your request, please call the Local Union office at 315.471.4164 ext 110.

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.