INTERNATIONAL ASSOCIATION of MACHINISTS and AEROSPACE WORKERS APPLICATION for RETIREMENT or EXEMPTION CARD

INTERNATIONAL ASSOCIATION of MACHINISTS and AEROSPACE WORKERS APPLICATION for RETIREMENT or EXEMPTION CARD
Date:

MonthDayYear
Date
Name:*
Card Number:*
Your union card number is required. If you do not know this, please exit the form and contact your Local Lodge Treasurer or Recording Secretary. Once you have acquired your card number, you may proceed with the application.
Local Lodge:
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
I hereby make application for the following as provided for by the IAM Constitution. (check one)
I hereby make application for the following provided for by the IAM Constitution. (check one)*

Retirement CardExemption Card
Date last paid wages, vacation, sick leave or severance pay. (Your official last day on the payroll of your company.)

MonthDayYear
Date
I am a member who has been in continuous good standing for 30 years or more.

YesNo
Date last paid wages, vacation, sick leave or severance pay. (Your official last day on the payroll of your company.)

MonthDayYear
Date
Signature*
If using a touchscreen (smartphone, iPad, etc.) simply use your finger or stylus pen to sign your name. If on a computer or laptop without touchscreen capabilities, please use your mouse to create a signature to the best of your ability.
Should be Empty: