Brazosport/Angleton AFT Membership Application

Brazosport/Angleton AFT, 1227 Hwy 332, STE 4, Clute, TX, 77531

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First Name *

Middle Name

Last Name *

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Billing Country *

Billing Address *

Billing Suite

Billing City *

Billing State *

Billing Zip Code *

also mailing address

Mailing Country *

Mailing Address

Mailing Suite

Mailing City

Mailing State

Mailing Zip Code

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Home Phone

Mobile Phone

Preferred Phones

preferred

Personal E-mail *

Work E-mail

Employer

Worksite Location

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Position *

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Referred By (first and last name)

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Angleton employees: Form still in progress. Above, please select Brazosport

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If you work in Angleton, Which campus are you assigned to?

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Select your membership category

Dues Amount

$0.00

Total * draft

Payment Methods

bank draft

credit/debit card

account type

Credit Card Types

Visa

Master Card

Discover

American Express

Name on Card

Card Number

Card Expiration Date

Month

Year

Card Security Code

account type

Bank Account Types

checking

saving

Bank Name

Routing Number

Account Number

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Authorize

ELECTRONIC DUES PAYMENT

I authorize the above named entity to draft my bank account for the amount equal to my union dues. The monthly dues amount may change if required by local, state or national constitutions. I authorize my bank to adjust my monthly payment when notified by the named entity listed above. This authorization remains in effect until terminated in writing by me. These deductions will continue for this school year and future years, including any increases in dues, until terminated by me in writing.

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$0.00