USEP Dues Portal – USEP Dues Deduction Portal

USEP Member Authorization Form

Instructional dues are $31.97 per pay period.

SRP dues are 1.75% of straight time pay per pay period, capped at $31.97, and not including money from the Referendum.

First name required Last name required Mailing Address (please include full address, city, state, and ZIP) required

School/Worksite required Employee ID Cell Phone required Personal Email required Bargaining Unit required Recruiter (Person you spoke with about joining)

I authorize United School Employees of Pasco (USEP) to initiate the scheduled membership payment each payroll period to coincide with the District School Board of Pasco County’s (DSBPC) payroll dates in the amount as annually certified by said Organization. If the payment date falls on a date that the bank does not process payments, the payment will be deducted on the next day that the bank does process payment. I agree to maintain sufficient funds in my deposit account to permit the automatic transfer described above.

Account Holder Name (If different from above name) Financial Institution Name required Bank Routing Number required Checking Account Number required Note / Special Instructions (optional)

This authorization shall remain in full force and effect for all purposes while I am employed by the DSBPC or until revoked by me upon thirty (30) days advance written notice to USEP. If I am joining as part of an Incentive program, I agree to remain a member until at least one year from the date this application is submitted.

Employee Digital Signature required Date required