PRINCE WILLIAM FEDERATION OF TEACHERS
PRINCE WILLIAM COUNTY, VIRGINIA
LOCAL 2402, AMERICAN FEDERATION OF TEACHERS
MEMBERSHIP APPLICATION
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I hereby apply for membership in PWFT/AFT. PWFT Sponsor: _____________________________
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Name Home Telephone
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Street Address City State Zip
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Social Security Number PWCS Email Address Years Teaching
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Base School Subject Area Grade(s) Other School(s) You Work In
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Signature Date Home Email Address
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Annual Dues: (Full-time) TEACHER - $576.00 PARAPROFESSIONAL - $288.00
TO: PAYROLL OFFICE, PRINCE WILLIAM COUNTY SCHOOLS
SUBJECT: AUTHORIZATION FOR PAYROLL DEDUCTION OF MEMBERSHIP DUES
I hereby authorize semi-monthly payroll deductions for organizational dues for PWFT/AFT as follows (check one):
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$24.00 per pay period for full-time professionals
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$12.00 per pay period for half-time professionals and full-time paraprofessionals
I understand that the semi-monthly rate is based upon 24 deductions. I further understand that the rates listed above are subject to change and any rate change will be publicized. This authorization will remain in effect until canceled by me in writing.
NAME___________________________________________________________________________
SIGNATURE____________________________________SSN ______________________________
DATE____________________________________WORK LOCATION________________________
***PLEASE RETURN ENTIRE FORM TO PWFT OFFICE***
(by school system courier or mail)
Contacts: Bill Hosp 571.330.8623 or Kathy Russell 571.238.6798
PWFT * 2200 Opitz Blvd., Suite 105B, Woodbridge, VA 22191 * 703.490.3016 * FAX 703.490.6645
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TO: Payroll Office, Prince William County Schools
Effective this date, please cancel my payroll deduction for dues from_________________________________ Thank you.
SIGNATURE____________________________________________________DATE____________________
SSN_____________________________________SCHOOL________________________________________