Please only complete the attached beneficiary form if you are an A member or are in the process of upgrading your membership from BA to A. This form may be updated at any time. Be sure to write clearly and be sure to sign the form. The International Office will not accept forms with mistakes crossed out or forms that have white-out fluid applied to them.

*Return the completed form to the union hall to be notarized using the address below.

Attn: Miranda Hawkins

Local 17

17000 W. 12 Mile Road

Southfield, MI 48076

Beneficiary Form IO.pdf