Appendix B
UNITED FACULTY OF FLORIDA
UFF-FEA-NEA
SAMPLE UFF DUES DEDUCTION AUTHORIZATION FORM
Please fill out the form below and return it to:
__ [Name] __, President, UFF/UF Chapter, P.O. Box 112070, 308 Yon Hall
MEMBERSHIP FORM, UNITED FACULTY OF FLORIDA
Please Print Complete Information
_________________________ ___________________________________
Social Security Number Last Name First Name MI
_________________________ ___________________________________
Home Street Address Campus Address & P.O. Box Department
___________________________ _______________________________
City State Zip Code Office Phone Home Phone
___________________________ _______________________________
E-mail address – Personal/Home E-mail address – Office
Please enroll me immediately as a member of the United Faculty of Florida (FEA-NEA-AFT, AFL-CIO). I hereby authorize my employer to begin bi-weekly payroll deduction of United Faculty of Florida dues in such amount established from time to time in accordance with the constitution and bylaws of the UFF and certified in writing to the University Administration. This deduction authorization shall continue until revoked by me at any time upon 30 days written notice to the Office of Human Resources and to the United Faculty of Florida.
_____________________________________ _____________________
Signature (for payroll deduction authorization) Today’s Date
Return to the UFF State Office, 306 E Park Ave, Tallahassee, FL 32301, or to the UFF/UF Office, P.O. Box 112070, 308 Yon Hall, UF.
Visit the UFF/UF Chapter Web Site at http://www.uff-uf.org
UNITED FACULTY OF FLORIDA
UFF-FEA-NEA
SAMPLE UFF-PAC PAYROLL DEDUCTION
AUTHORIZATION FORM
United Faculty of Florida - Political Action Committee
306 E Park Ave
Tallahassee, FL 32301
850-224-8220
Please Print
University/College ___________________ Dept.: ____________________
Name: ________________________________________________________
Address: ______________________________________________________
City: _________________________ State: _____________ Zip: _________
UFF-PAC Payroll Deduction (For University of Florida Faculty)
I authorize the UF Board of Trustees, through the University Administration, to deduct from my pay contributions to the UFF Political Action Committee in the amount of $1 per pay period, and I direct that the sum so deducted be paid over to the UFF. The above deduction authorization shall continue until revoked by me through written notice to the Office of Human Resources and to the UFF.
_________________________________ ________________________
Signature (for payroll Today’s Date
deduction authorization)
Return to the UFF State Office listed above, or to the UFF/UF Office, P.O. Box 112070, 308 Yon Hall, UF.