FCFPSA Member Application General Membership Form Please enroll me as a member of the Fairfax County Federation of Principals, Supervisors, and Administrators (FCFPSA), Local 147 of the American Federation of School Administrators (AFSA), and any successor organization. By becoming a member, I agree to adhere to all rules and policies established by FCFPSA members. This authorization permits my employer to deduct the membership fee from my salary each pay period. The membership fee is set at 0.4% of my salary or any approved future adjustment. My employer will remit these funds to FCFPSA monthly. I authorize FCFPSA to serve as my exclusive representative in collective bargaining. This includes negotiations on pay, benefits, working conditions, professional development, and other related matters as permitted by law. I understand that I will have the opportunity to provide input on bargaining topics and retain the right to vote on agreements, organizational leadership, and other matters brought to the membership. This authorization is binding and may only be revoked in writing during the designated period of June 15 through June 30 each year. After this period, the agreement will automatically renew annually. I acknowledge that my decision to join FCFPSA and authorize the deduction of membership fees is entirely voluntary and is not a condition of my employment. First Name * Last Name * Job Title * Job Location * Home Address * Home Address Home Address Home Address City City State/Province State/Province Zip/Postal Zip/Postal Work Phone * Personal Cell Phone * Employee District ID Number * Personal Email * District Email * Position your mouse cursor in the signature box below. Press and hold the left mouse button to draw your signature. Your Authorization Signature * signature keyboard Clear Date * Submit If you are human, leave this field blank.
