Online Request Form for Retirement Pins and Certificates President’s Name Name of Local Address Contact # E.D. # Do you have a retiree reception/recognition planned for 2021? – Select –YesNoMaybeIf yes, when is your event? Tell us about your event: How will you be giving out retirement pins and certificates? – Select –At an eventAt the workplaceThrough the mailOtherHow many members are retiring? Retiree NamesHere’s the information on the 2020 retirees, including SRPs.Name Retirement Date Address Email (non-work) Job Title Name Retirement Date Address Email (non-work) Job Title Name Retirement Date Address Email (non-work) Job Title Name Retirement Date Address Email (non-work) Job Title Name Retirement Date Address Email (non-work) Job Title Name Retirement Date Address Email (non-work) Job Title Name Retirement Date Address Email (non-work) Job Title Name Retirement Date Address Email (non-work) Job Title Name Retirement Date Address Email (non-work) Job Title Name Retirement Date Address Email (non-work) Job Title Submit Form
