Please email your change of address and/or withdrawal request to
March 19, 2009 Contract
Local 72 By Laws
We now have two forms that relate to your
Personal History File.
The first form lets request of copy of your PH
The second will let you list the items that
you would like removed from you file.
To view and print these forms you'll need
Adobe's Acrobat Reader.
here for the first form. (Use this form to request a copy of
your PH Folder)
here for the second form. (Use this form to request the
removal of items from your PH Folder)
Change of Address Form (PDF)
Change of Address Form
Schedule of Allowances for Dental Plan.
Lower New York Area
Out of network
Dental Form Group # GG 258
Davis Vision Reimbursement
for non participating providers
Disability Form for Part Time Members
Please call the NY office for a Employee
/Dependents Enrollment Form.
One will be mailed to mailed to you with a
postage paid return
Insurance Form (Please contact our NY Office or your Business
Omnibus General Information
Vision Care Summary Booklet
Union members please be advised as to your right
and responsibility to request a union withdrawal card if
you are going out of work for an extended period of time.
If you are going to be out of work for an
extended period of time, you MUST call the
Local 72 office at 212 691 4228 or fill out the on line
application to request a withdrawal. The withdrawal will
relieve you of your obligation to pay union dues during the
withdrawal period. Failure to request a withdrawal will
continue your obligation to pay union dues, even though you are
not working and may not be receiving pay from the NYSTA.
Failure to pay these dues may affect your union
status and lead to suspension. You are responsible for
paying all dues in arrears to obtain "good standing status".
If you have any questions, please contact the office.
Withdrawal Form (PDF)
Union Privilege scholarships click