[NOTE: Please print out, complete, and sign this letter. Then make four copies of the completed and signed letter and send a copy to the UAW Local Financial Secretary, another copy to the UAW International Financial Secretary, another copy to your employer, and retain the final copy for your records. It is recommended that you send each of the three copies by certified mail, return receipt so you have proof of their delivery. If you are a Ford employee, UAW and Ford may try to require you to send the copy of your letter to the employer by registered mail. Although the Foundation does not believe these certified or registered mail requirements are legal, the choice is up to you on whether you would like to send the letters regular mail; certified mail, return receipt; or registered mail.]

_______________________ , Financial Secretary

UAW Local____________________________________

_____________________________________________
Address

_____________________________________________
City, State, Zip Code

and

Gary Casteel, Financial Secretary
United Auto Workers International Union
8000 East Jefferson Ave.
Detroit, MI 48214

and

Human Resources Department

_____________________________________________
Employer

_____________________________________________
Address

_____________________________________________
City, State, Zip Code

Re: Membership Resignation and Dues Check-off Revocation

Dear Sirs:

I am employed by_______________________________________in a Right to Work state. Effective immediately, I resign from membership in the UAW union and all of its affiliated unions.

Since I have resigned my membership in the union, you must immediately cease enforcing the dues check-off authorization agreement that I signed. That check-off authorization agreement is hereby revoked. I signed that check-off authorization solely in conjunction with, and in contemplation of, my becoming a member of the union; and, as such, it is no longer valid. See IBEW (Lockheed Space Operations Co.), 302 NLRB 322 (1991); Wash. Gas Light Co., 302 NLRB 425 (1991) (employer in Right to Work state must cease dues deduction upon receipt of resignation/revocation).

If, for any reason, you refuse to accept this letter as both an effective resignation and an immediately effective dues check-off revocation, I ask that you promptly inform me, in writing, of your reasons for so doing, and send me a copy of the actual dues check off authorization form I signed.

_______________________________________
Name (print)

_______________________________________
Signature

_______________________________________
Address

_______________________________________
City, State, Zip Code

_______________________________________
Today’s Date