Join PBA Application

Florida Police Benevolent Association Membership Application

Member Dues Billing Options (Pick One)

OPTION 1

Bank Draft - I authorize FLPBA to deduct from my personal account listed below the current monthly dues for membership. I understand deductions will be processed on the 5th of each month. This authority will remain in effect until such time as I provide written notice to FLPBA to terminate. I can stop payment at any time.

OPTION 2

Credit Card - I authorize FLPBA to deduct from the credit/debit card listed below the current monthly dues for membership. I understand deductions will be processed on the 5th of each month. This authority will remain in effect until such time as I provide written notice to FLPBA to terminate. I can stop payment at any time.

Please select if you prefer to make a one-time yearly payment processed upon receipt and receive a 10% discount.

OPTION 3

Individual Billing - I direct FLPBA to mail a monthly billing statement to the address provided in the application.

OPTION 4

Payroll Deduction - I direct my employing agency to deduct from my wages the appropriate FLPBA dues in accordance with collective bargaining or other agreement between PBA and the agency, if available. This authority will remain in effect until such time as I provide 30 days written notice to FLPBA and the agency to terminate said deduction.

Select or enter your agency below:

FDC 0673FHP 0658FDLE SA 0680SLEO 0699

Recruitment Information - If Applicable

Each member who recruits another member may receive $25.00 from the Florida PBA!

Electronic Signature

By selecting the "Send" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual and/or handwritten signature on this Agreement. By selecting "Send" using any device, means or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing.