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 Employment: 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) Original: Copies: UAF HR FFA, Employee Start Date: Entered By: End Date Date Revised 4-13-11