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2. Please cancel the deduction of my weekly_____Union dues.*

   1. LIUNA
   2. PBA
   3. IAFF
4. Effective the next payroll cycle of*
6. Signature*
   By typing my name in this form, I affirm the accuracy of information provided on this application. I understand that this constitutes a legal signature and confirms that I agree to the above terms.
7. Date*
9. Print Name*
10. Employee ID#*
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12. 1. Receive an email copy of this form.
13. Email address

    This field is not part of the form submission.

14. Submit

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