Member Information Form

The Broward Teachers Union is hereby designated as my agent to represent me with my employer.

I also agree to pay my dues electronically via deduction from the bank account I designate, or by check in four equal installments or in one check, in an amount sufficient to provide for regular payment of the membership dues as certified from time to time by the organization.

I understand that such deduction is revocable upon thirty (30) days written notice to the employer and union. I hereby waive any right and claim for said monies or deducted and transmitted in accordance with this authorization.