Step 1: Your Information

First Name

Last Name

Address Line 1

Address Line 2

City

State

FLALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Zip Code

Email

Phone Number and Area Code

The best way to contact you is : PhoneEmail

Printed Name

Name as you would like it to appear in printed materials:

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Please answer the following question to confirm that this is not SPAM.

What is 3+4?

 

Payroll Deduction

I am an employee of : University of FloridaShands

UF / Shands Employee ID Number

Step 2: Membership Level

Step 3: Before clicking submit...

Please check that all above information is correct. When you click the submit button below, your information will be sent to UFPA Development staff. They will complete a UF Foundation Payroll Deduction Authorization form on your behalf, and send it to you to request your digital signature via DocuSign.

Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing. UF Privacy Policy