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I hereby authorize the Federation of Public Employees, a division of the National Federation of Public and Private Employees, AFL-CIO, to represent me in any and all negotiations relative to collective bargaining with my present employer. This authorization shall continue in full force and effect until I have revoked same by written revocation delivered to the Federation of Public Employees, a division of the National Federation of Public and Private Employees, AFL-CIO, located at; 1700 N.W. 66th Avenue • Suite 100 • Fort Lauderdale, Florida 33313 I hereby apply for membership in the Federation of Public Employees, a division of the National Federation of Public and Private Employees (AFL-CIO), an affiliate of District 1 – MEBA (AFL-CIO). In so doing, I agree and promise to faithfully obey the Constitution and By-Laws and to conform to all the rules of the Federation, pending the final acceptance as a member. Further, I attest that I do not believe in, and am not a member of, nor do I support any organization that believes in or teaches the overthrow of the United States government, by force or by illegal or unconstitutional methods. I certify that the statements in this application are true. I further designate the beneficiary identified below for purposes of any and all union sponsored benefits unless otherwise designated on a separate form specific to that benefit.

I hereby authorize the Federation of Public Employees, a division of the National Federation of Public and Private Employees (AFL-CIO), an affiliate of District 1 – MEBA (AFL-CIO), to deduct my periodic dues in such amounts as are now or hereafter established by the Federation and become due to it as my membership dues in said Federation. This assignment, authorization and direction shall be revocable at any time upon thirty (30) days written notification to my employers and the Federation. Dues, contributions or gifts to the Federation of the Public Employees, a division of the National Federation of Public and Private Employees (AFL-CIO), an affiliate of District 1- MEBA (AFL-CIO), are not deductible as charitable contributions for Federal Income Tax purposes. Dues paid to the Federation of Public Employees, a division of the National Federation of Public and Private Employees (AFL-CIO), an affiliate of District 1 – MEBA (AFL-CIO), however, may qualify as business expenses and may be deductible in limited circumstances subject to various restrictions imposed by the Internal Revenue Code.

Please call the FOPE office at 954-797-9797 Ext 232.