First Name

Last Name

Membership No

Customer Ref No

Email Address

Would you like to: Would you like to: Resign Suspend Membership

Date to take affect *

Reason Reason No longer working in the trade/industry Retired Unemployed Transferring interstate to work Moving overseas Other

If other why?

I agree that I will be liable for any union contributions and levies owing up to the date of cancellation of my membership. I agree that I will be liable for any union contributions and levies owing up to the date of cancellation of my membership. I agree that I will be liable for any union contributions and levies owing up to the date of cancellation of my membership.

I understand and acknowledge that if I put my membership on HOLD, I will not be eligible to receive membership assistance including Legal advice / Workcover support from the CFMEU I understand and acknowledge that if I put my membership on HOLD, I will not be eligible to receive membership assistance including Legal advice / Workcover support from the CFMEU I understand and acknowledge that if I put my membership on HOLD, I will not be eligible to receive membership assistance including Legal advice / Workcover support from the CFMEU