IBEW Local 659

Membership Cancellation Form

First Name:
Last Name:
Email Address:
Phone Number:
Address:
Member ID:
Classification:
I understand that this request to let my membership drop will result in the following:
I recognize that by no longer paying dues and submitting this request, I will forfeit all prior IBEW pension credits and death benefits
I have consulted with an IBEW 659 employee and understand the pros and cons for moving forward with this request.
I will not be responsible for accrued dues and past dues will not be reported to a credit agency nor will it have a negative impact in the future.
Signature: Use your mouse, finger, or touch device to write your signature.
Comments: