Membership Dues Deduction Form Please Print Name (First and Last)

Membership Dues Deduction Form
International Association of Fire Fighters
Fairbanks Fire Fighters Association –Local 1324
PO BOX 71739, Fairbanks, Alaska 99707
Major Admin Unit – UAF
Date of Hire
Employee ID Number
Work Phone
Please Print
Name (First and Last) ____________________________________________________________
Mailing Address ________________________________________________________________
City ________________________ State _______________________ Zip ___________________
Email Address _________________________________________________________________
Subject to the limitations of applicable Alaska and federal laws, and in accordance with the Collective Bargaining
Agreement between the IAFF Local 1324, FFA and the University of Alaska, payment of the following is a condition of
I elect to join the International Association of Fire Fighters as a Member with full
membership benefits, privileges and voting rights. Dues, initiation fees and assessment
costs are determined by the membership according to the bylaws. I authorize deduction
of Local 1324 membership charges.
Employee Signature: ______________________________Date ____________________
For University of Alaska office use only (PDADEDN)
Dedn Code = 630 (dues)
FFA, Employee
Start Date:
Entered By:
End Date
Revised 4-13-11