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.