APPENDIX B
UNITED
FACULTY OF FLORIDA
UFF-FTP-NEA
UFF
DUES CHECK-OFF AUTHORIZATION FORM
I,
_____________________________________, authorize the Florida Board of Regents,
through the university, to deduct from my pay, starting with the first full
biweekly pay period commencing not earlier than seven days from the date this
authorization is received by the university, membership dues of the United
Faculty of Florida in such amount as may be established from time to time in
accordance with the constitution and bylaws of the UFF and certified in writing
to the Florida Board of Regents by the UFF, and I direct that the sum so
deducted be paid over to the UFF.
UFF-FTP-NEA dues payments
and contributions to FTP-PAC are not tax deductible as charitable
contributions for federal income tax purposes.
However, they may be tax deductible under other provisions of the
Internal Revenue Code.
The above deduction
authorization shall continue until either (1) revoked by me at any time
upon thirty days written notice to the Florida Board of Regents, University
Personnel Office, and to UFF, or (2) my transfer or promotion out of this
bargaining unit. Unless this Dues Check-off Authorization is revoked in the
manner heretofore stated, this authorization shall remain in full force and
effect in accordance with the provisions of Section 447.007 Florida Statute.
________________________________ ______________________
Date Employee's
Signature
________________________________ _____________________
Social Security Number Name-printed
________________________________ _____________________
Department University
Effective date if later than
above:
Please return to your Chapter Treasurer or UFF State
Office, FTP-NEA Building, 213 South Adams Street, Tallahassee, Florida 32301.
Please PRINT complete
information where necessary.
Check One
_______________________ Dr. Mr. ________________________
Social Security Number Ms. Mrs.
Last Name, First Name
____________________________
Home Address
______________________________ ________________________
Campus Address Department
____________________________ ________________ _________________
City, State, Zip
Code Office
Phone Home
Phone
Please enroll me as a member
of the United Faculty of Florida (UFF-FTP-NEA).
All UFF members are also
members of the Florida Teaching Profession-National Education Association,
FTP-PAC (Political Action Committee), and the National Education Association at
no additional cost.
UFF-FTP-NEA dues are 1
percent of total salary* for members for which the United Faculty of Florida is
the bargaining agent. If you do not
wish to contribute to FTP-PAC, notify FTP-NEA for refund information. UFF-FTP-NEA dues payments and contributions
to FTP-PAC are not tax deductible as charitable contributions for Federal
income tax purposes. However, they may
be tax deductible under other provisions of the Internal Revenue Code.
*Total salary for purposes
of dues deductions includes any money received by the employee for in-unit
work. If insufficient funds remain
after mandatory deductions, the university has no obligation to process dues
deductions.
______________________________
Signature of Member Date
Return your completed
membership form to your Chapter Treasurer or UFF State Office, FTP-NEA
Building, 213 South Adams Street, Tallahassee, Florida 32301.
