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Withdrawal Card Request Form
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Name ________________________________________________________ Address ______________________________________________________ _____________________________________________________________ Phone (_____) _________________________________________________ Company you worked for _________________________________________ Last Day Worked _______________________________________________ Your Dues and Initiation must be paid up to date. You have 60 days from your last day worked to submit this form. There is a fee of 50 cents. Print out and Mail completed form with 50 cents to: Phone: 216-328-1833 or 800-506-4360
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