Membership Application

AUTHORIZATION TO DEDUCT DUES
INTERNATIONAL UNION OF POLICE ASSOCIATIONS

TO/EMPLOYER: Volusia County, RE: I.U.P.A. Local 6035

I hereby assign to the International Union of Police Associations, from any wages earned or to be earned by me as your employee, my periodic dues in such amounts as are now or hereafter established by the International Union of Police Associations. I authorize and direct you to deduct and withhold such amounts from my salary and to remit the same to said International Union of Police Associations. I hereby waive all rights and claims to said monies deducted and transmitted in accordance with this authorization, and release my employer and all its officers from any liability therefore.

This assignment, authorization and direction shall be revocable any time upon thirty (30) days prior written notification to my employer and the International Union of Police Associations.

Name of Employee (required)
[text* your-name]

Signature of Employee (required)
[text* your-Signature]

Employee Number (required)
[text* your-Employee]

Date Signed (required)
[text* the-Date]

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MEMBERSHIP APPLICATION –

Volusia County Deputies Association, I.U.P.A. Local 6035

I, the undersigned, do hereby apply for membership in the International Union of Police Associations.

Name of Employee (required)
[text* your-name]

Signature of Employee (required)
[text* your-Signature]

Position (required)
[text* your-Position]

Date Signed (required)
[text* Date-Signed]

Address (required)
[text* your-Address]

Contact Phone Number (required)
[text* your-Number]

Personal Email (required)
[text* your-email]

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Volusia County Deputies Association, I.U.P.A. Local 6035
Political Action Committee

I hereby authorize the leadership of I.U.P.A. Local 6035 to use a portion of my dues deduction as a contribution to I.U.P.A. Local 6035’s Political Action Committee. $5.00 per month, of my dues, will be contributed by I.U.P.A. Local 6035 on my behalf to its Political Action Committee.

I understand that this voluntary payment is not a condition of employment or of membership in the union and that the union cannot favor or disadvantage me because of the amount of my contribution or my decision not to contribute; that I have the right to refuse to sign this authorization and to refuse to contribute to I.U.P.A. Local 6035’s Political Action Committee without reprisal; and that by I.U.P.A. Local 6035’s Political Action Committee will use the money received to make political expenditures and contributions in connection with local elections. This authorization shall remain in full force and effect until revoked by me in writing and sent to by I.U.P.A. Local 6035, to be effective on the payroll period 30 days from the date of notice. Contributions to I.U.P.A. Local 6035’s Political Action Committee are not deductible as charitable contributions for federal or state income tax purposes.

Signature of Employee (required)
[text* your-Signature]

Name of Employee Printed (required)
[text* your-Name]

Date Signed (required)
[text* your-Date]

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