Form

Deduction Authorization
Macomb Intermediate Federation of Teachers
Membership Dues or Service Fees Local #2144
2011-2012
Professional's Last Name:*
Professional's First Name*
Location:*
Amount Due: $680.00
I hereby authorize the Macomb Intermediate School District to deduct the above Amount Due (total), to be paid in full, to the Macomb Intermediate Federation of Teachers. This authorization is to continue in full force and effect until such time as my employment is terminated, a change in assignment removes me from the bargaining unit, or until this authorization is revoked or changed by written notice. I further authorize the Federation's Treasurer to change the amount of this deduction when such a change has been adopted by a vote of the membership as prescribed by the Constitution of the Macomb Intermediate Federation of Teachers.
Check One of the following:
Check ONE of the following:*

Representating My Dues for Membership in the Macomb Intermeidate Federation of Teachers, AFT, MFT, AFL-CIO As a Service Fee representating my proportionate share of the Collective Bargaining costs of the Macomb Intermediate Federation of Teachers.
By initializing this form I give complete authorization and will be considered as a digitial signature:*
Date of digital signature:
- Month - Day Year
at
/ Hour Minutes
Payroll deductions will start approxiamately the 2nd pay in October and will last for 20 pays.
If you wish to pay the FULL amount by check please check here:

I prefer to pay the FULL amount by check. Check is due to the Treasuer by NOON on Wednesday before Thanksgiving. Any balance due after noon on Wednesday before Thanksgving will be sent to payroll for deduction.
Make checks payable to MIFT, Local 2144 and send to Tim Zimmerman, Center Programs, MISD Service Center
Should be Empty:

Deduction Authorization

Macomb Intermediate Federation of Teachers

Membership Dues or Service Fees Local #2144

2011-2012