Retirement Gift Pickup Please fill up this form before picking up the Retirement Gift! Retirement Gift Pickup Pickup Date Are you a member or designated pickup person? * I’m a member and picking up this Retirement Gift for myself I’m a designated pickup person and picking up this Retirement Gift for a UFLAC member Items that you picked up: * Retirement Ring Retirement Axe Member’s Name (for who you are picking up the Retirement Gift) * Member's Name (for who you are picking up the Retirement Gift) First First Last Last Your Name * First Last * Last Your Phone Number * Your Email Address * Note to UFLAC (optional) Submit If you are human, leave this field blank.
