Fairfax Co. Federation of Teachers Member Application

personal-information-1

First Name *

Middle Name

Last Name *

billing-address

Mailing Country *

Mailing Address *

Mailing Suite

Mailing City *

Mailing State *

Mailing Zip Code *

personal-information-2

Home Phone

Mobile Phone

Preferred Phones

preferred

Personal E-mail *

Work E-mail

custom-field-1

Employee ID *

custom-field-2

School *

custom-field-3

Referral or Recruiter Name

custom-field-4

Job Classification *

custom-field-5

T-Shirt Size

payroll-deduction

membership-wrapper

Select your membership category

Dues Amount

$0.00

Total * draft

privacy-policy

legal-wrapper

Authorize

I hereby apply for membership in the FCFT.

I authorize FCPS to withhold from my salary a sum equal to the constitutional monthly dues of the Federation. This authorization may be revoked by me in any month by written notice to FCFT. I will be responsible to notify FCFT, in writing of any change in my job status with FCPS. FCFT will not refund any dues paid without written notice and approval by FCFT. Dues paid to employee organizations may not be deductible for federal income tax purposes; however, under limited circumstances, dues may qualify as a business expense.

Print your name

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Math question * 9 + 9 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

Leave this field blank

We're sorry but our site requires JavaScript enabled in your browser.

$0.00