Employee Organization Membership Authorization Form

(PERC FORM 2023-1.101, Incorporated in R. 60CC-1.101, Effective July 1, 2023) Exemptions from this form are provided in section 447.301(1)(b)6., Florida Statutes, as amended by chapter 2023-35, section 1, Laws of Florida.

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Authorization

BY SIGNING THIS DOCUMENT ELECTRONICALLY, I CONSENT TO ENTER INTO THIS AGREEMENT FOR AUTHORIZATION OF DUES DEDUCTION WITH THE LOCAL UNION. I HAVE READ, UNDERSTAND, AND SUBMIT THIS APPLICATION TO BE ADMITTED AS A MEMBER OF THE LOCAL UNION.

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