PESPA Join the Union!

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First Name *

Middle Name

Last Name *

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Mailing Country *

Mailing Address *

Mailing City *

Mailing State *

Mailing Zip Code *

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Home Phone

Mobile Phone

Preferred Phones

preferred

Personal E-mail *

Work E-mail

Work Location

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Recruited by

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Job Title *

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Registered Voter?

Yes

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Party

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Select your membership category

Dues Amount

$0.00

Total * draft

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Authorize

PLEASE call 727-585-6518 any time there are changes in any of the information above. Signing this form authorizes the Association named above to make deductions for dues, assessments and contributions.

PAYROLL DEDUCTION: I hereby agree to pay, and authorize my employer to deduct the dues, assessments and contributions described above and as are certified by the Association to the School Board for each year thereafter from my salary and direct and authorize my employer to pay such amounts to the Association in accordance with payroll deduction procedures in effect: provided, how- ever, I may cancel my membership and this authorization by providing 30 days written notice to the Association notifying it of such revocation as provided by law. I further understand that the dues may be adjusted annually as prescribed in the Association’s governing documents and the employer is authorized to withhold any increased amounts unless this authorization is terminated.

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