Miami-Dade and Broward
I hereby make application for membership in the Progressive Firefighters Assoc. Charities, Inc. Miami Dade/Broward County,Florida.
Country: Zip Code:
Name of Department:
Date of Hire (Miami-Dade/Broward County):
Employee ID # : on pay stub.
Name: Age: Sex:Select OneMaleFemale
I hereby request and authorize the Progressive Firefighters Assoc.Charities, Inc. Miami Dade County, Florida to deduct from my earnings each payroll period the sum of $15.00. This amount shall be paid to the Progressive Firefighters Assoc.Charities,Inc. and represents payment of my dues. I understand that these deductions can only be terminated by my giving the Progressive Firefighters Assoc.Charities,Inc. prior written notice.