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:

 

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 and click the following box to confirm that this is not SPAM. 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.

THIS IS NOT SPAM

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