DRIVE Withdrawal Form

National DRIVE Stop Deduction Request Form
Name*

First NameLast Name
Employer*
Address*

Street Address

Street Address Line 2

CityState

Zip
Phone Number*

Area CodePhone Number
Titan ID or SSN4*
Local Union*
Date*

MonthDayYear
Date
Email*
example@example.com
I understand that upon receipt of this form, DRIVE will remove my name from its contributor list and notify my employer of my request. I further understand that this process can take four to six weeks and that during this period further deductions might be made by the employer.

It is also understood that this completed form must be submitted directly to the principal officer of my local union and in turn forwarded to National DRIVE.

This form is a request for my deductions to and membership of DRIVE to cease. This request without reprisal and in no way affects the status of my union membership.
Signature*
Please verify that you are human*
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