UFLAC Retirement Gift Request Form

(Retirees in Good Standing)

As you prepare for your upcoming retirement, we here at UFLAC want to make sure that we are able to honor and celebrate your personal moment with proper time preparation.  To commemorate your retirement, UFLAC gives all retirees either receive a retirement ring or retirement axe.  You can choose which one you’d like to receive as a gift.  If you choose to receive both, you will be responsible to pay for $225 the ring.

Please note – for the ring, we will need you to provide your ring size.  If you are unsure of your ring size, please download and use this ring size guide.

To submit your retirement gift request, please fill out the form below.  Once completed and submitted, a staff member from UFLAC will follow up on your request to make sure that we are able to properly celebrate your personal day.

Please provide at least 2 months advanced notice from your retirement date so that we can ensure that your gift will be ready in time.

Name *

First

Last

Phone *

Email *

Badge Number *

Start Date *

MM/DD/YY

Retirement Date *

MM/DD/YY

Will You Be Having a Retirement Event? *

• Yes
• No

If you selected "Yes", please provide the date of your retirement event in the next field. If "No", please skip the next question.

Retirement Event Details (Date, Time, Location, Cost To Attend, etc.) - If Applicable

Select Your Retirement Gift *

• Retirement Ring - Free
• Retirement Axe - Free
• Both - $225

If you select both, please note that payment in the amount of $225 will be due on the date that you pick up your items at the UFLAC offices. Payment should be in the form of a check made payable to: UFLAC

For Ring - Ring Size

If unsure about your ring size, please reference the downloadable ring size document at the top of the page.

For Axe - Name As You'd Like It To Appear (Nicknames Are Allowed)

For Axe - Your Rank and Rank Date (for "Firefighter", no date is needed)

Comment or Message

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