Collective Bargaining Membership Form

South Florida Police Benevolent Association Membership

PBA Membership Application - Collective Bargaining

Employee ID #(Required)

Agency Name(Required)

Full Name(Required)

First Middle Last

Badge ID #

Employment Type(Required)

Full Time

Part Time

Home Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Cell Phone(Required)

Home Phone

Work Phone

Date of Birth(Required)

Date of Employment(Required)

Rank(Required)

Personal Email(Required)

Work Email(Required)

Registered Voter?(Required)

Yes

Sex(Required)

Male

Female

Signature

I am hereby applying for membership in the South Florida Police Benevolent Association (PBA). I understand that upon my membership acceptance, I agree to abide by the Constitution, By-Laws, and Policies of the South Florida PBA.

Date

Recommended by PBA Member

First Middle Last

Recommended by PBA Board Member

First Middle Last

Payroll Deduction Request

Name of Law Enforcement Agency(Required)

Name(Required)

First Middle Last

Job Classification(Required)

Assignment Location(Required)

I hereby request and authorize the payroll department to deduct the South Florida PBA dues from my payroll earnings. These deductions may be terminated by giving thirty (30) days written notice to the PBA, or upon termination of my employment.

Signature(Required)

Date(Required)

South Florida Police Benevolent Association Membership

PBA Membership Application - Collective Bargaining

Payroll Deduction Request

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