10 month employee____ MEMBERSHIP APPLICATION
12 month employee ____
PUTNAM FEDERATION OF TEACHERS/UNITED
P.O. Box 934 Phone: 386 325-7882
Palatka, Fl. 32178 800-891-2739
Fax: 386 325-7472
Social Security Number Job Title Worksite
________________________________________________________________________Employee Name Address City/St./Zip
Employee Signature Date Home phone Rep’s Signature
I authorize the School Bd. Of Putnam County to deduct membership dues from my paycheck to be remitted to PFT/U. I understand that I may terminate the deduction at any time by submitting (30) days written notice to the School Board payroll dept. and PFT/United office.