Member Firstname *

Member Lastname *

Membership No. *

Customer Ref No. (CRN) *

Email Address *

Select one option only: * Select one option only: * Resign Suspend Membership

Date to take effect *

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.