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LOCAL 399 WITHDRAWAL CARD

Form for a Local 399 Member to place account on a Withdrawal Status. Completion of this form is not a confirmation of a Withdrawal status. A Local 399 Member Specialist will confirm when your account has been placed on a Withdrawal status.

Local 399 Member:*
First Last
Local 399 Member: Last 4 SSN*
Phone*
Email*
I am currently on a Local 399 Recurring Payment Plan:*
- Yes
- No
- I do not know
My dues paid through date is:*
- I am not aware of my paid through date.
Please confirm you are not actively working at this time.*
- Yes, I am not currently working under a Local 399 covered position at this time.
I would like to place my account on Withdrawal.*
- Yes! (I understand it is my responsibility to contact the Union Hall prior to my first day worked to pay my dues and come off of a “Withdrawal” Status.)

General

Chef Assistant

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Standard

Casting Assistants

Chef Assistants

LOCAL 399 WITHDRAWAL CARD