USEP Member Authorization Form

USEP Member Authorization Form
All public sector unions (except police and firefighter unions) are required by Florida Statute 447.301 to obtain a signed copy of this form from every member.
***THE EMPLOYEE MUST PERSONALLY SIGN AND COMPLETE THE DATE OF SIGNATURE***
NAME OF EMPLOYEE (First Name Middle Name Last Name):

First NameMiddle InitialLast Name
Job Title
(Class Title)
By my signature below, I represent that I desire to be a member of the above-named employee organization.
Signature of Employee

Please type your name to enter your signature
Date of Signature

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
District Email Address
example@pasco.k12.fl.us
Should be Empty: