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Revised Jan. 2012

INACTIVE STATUS APPLICATION

MEMBER’S INFORMATION: Please type or print in ink

Date ____________________

Name

Daytime Phone ( First

)

Last

Email Address: ___________________________________________ Member ID# or last 4 digits of Social Security#__________________

Inactive status is available to Guild members who are not working or do not intend to work in their craft(s) within the Local 800 jurisdiction, but wish to maintain their membership with the Guild. If this application is approved, inactive status will become effective in the quarter following approval.

REASON FOR INACTIVE STATUS REQUEST: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

This certifies that I am not working nor intend to work in my craft(s) that I am a member of and wish to apply for Inactive Status. If and when I do return to work within the Local 800 jurisdiction, I will inform the Guild of my employment and will pay the appropriate rate/balance for the current quarter in which I seek to pay inactive dues.

I affirm that the information I have provided is true and correct.

____________________________________ Member’s Signature

Date:_____________________________


Revised Jan. 2012


INACTIVE_STATUS_APPLICATION_2012