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Federation Membership Application
Application for membership in Portland Community College Federation of Faculty and Academic Professionals (PCCFFAP, Local 2277 of AFT, NOLC, AFL-CIO)

Yes, I want to join my co-workers in PCC Federation of Faculty and Academic Professionals (PCCFFAP, AFT Local 2277). I acknowledge that Portland Community College will deduct from my paycheck the appropriate amount of monthly dues, as designated by the Federation's treasurer, and that this monthly payment entitles me to full membership privileges.

First name and last name *
Your answer
G number (if known)
Your answer
Street address (incl. Apt/Unit No., if applicable) *
Your answer
City, State, ZIP code *
Your answer
Office/Intercampus address (ex. SY ST 01) *
Your answer
Department (ex. German, Library, Math, etc.) *
Your answer
PCC e-mail
Your answer
Non-work e-mail
Your answer
PCC extension (-xxxx format)
Your answer
Cell phone (xxx-xxx-xxxx format)
Your answer
Home phone (xxx-xxx-xxxx format)
Your answer
Employee category *
Certification
I understand that union dues may not be deductible for Federal income tax purposes; however, under limited circumstances, dues may qualify as a business expense. I further certify that my electronic signature has the same force and effect as my written signature. I understand that I will be contacted by a staff member or officer of PCCFFAP to verify my intent to become a dues-paying member.
Today's date *
MM
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DD
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YYYY
Signature (type your full name) *
Your answer
How to submit this form
Click the "Submit" button below, or print, sign, and send to us via Intercampus Mail to SY ST 01 or via US mail (with a stamp) to PCCFFAP, PO Box 19389, Portland, OR 97280.
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