PBA Application – Payroll Deduction

Florida Police Benevolent Association Membership Application

Home/Mailing Address (required)

Payroll Deduction Billing:

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:

Recruitment Information - If Applicable

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

Electronic Signature

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. My signature hereon is authorization to release my social security number when reporting dues deductions.

IMPORTANT NOTE: MEMBERS WILL BE REDIRECTED TO AN E-SIGNATURE PAGE AFTER SUBMISSION OF APPLICATION. MEMBERS MUST SIGN THIS AGREEMENT ELECTRONICALLY IN ORDER FOR THE FLORIDA PBA TO SUBMIT REQUEST FOR PAYROLL DEDUCTION TO APPLICANTS AGENCY.