Membership Application Authorization Form

*Money order or cashier's check made out to DPSOA Associate Member

Section C: CC Authorization / Check

Annual Deduction: $60.00 per year - Paid by cc, money order, or cashier’s check

I understand that I cannot be compelled to be a member of a state employee organization or to pay dues to a state employee organization as a condition of employment with the state. While I am free to join a state employee organization, I understand that I may change or cancel this authorization at any time by providing written notice. I voluntarily authorize an annual baument in the amount shown above for membership fees to the state employee organization listed above and agree to comply with the comptroller’s rules concerning this deduction. I agree that my name, personal contact information, and the amount of my membership fees may be provided to the state employee organization listed above only for the purpose of informing the state employee organization about the membership. Please note that our dues are not tax deductible.