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Federation of Physicians & Dentists

Alliance of Healthcare and Professional Employees

  Click here to view PATCO Application (.pdf format)
Click here to download Adobe Acrobat Reader
 

PATCO

 Professional Air Traffic Controllers Organization

  Payroll Deduction Authorization Form

 Please Fill Out Completely

Please Print

 Dues are two (2) hours pay per month / additional $1.00 per pay period for COPE (political action) option

 NAME___________________________________________________________

ADDRESS________________________________________________________

 CITY_________________________________STATE_______________ZIP

 HOME PHONE______________________WORK PHONE_______________

 FAX__________________________________SSN______-______-________

 CURRENT FACILITY___________________________________________________

 POSITION________________________________________________________

  __________________________________________________________________

Signature                                                                                                        Date

  Please check your choice

Option 1 – dues only_____

Option 2 – dues plus COPE_____

  Mail to:    PATCO

                                1310 Cross Creek Circle, Suite C-2

                                Tallahassee, Florida 32301

Or Fax to:                     850-942-6722

Professional Air Traffic Controllers Organization