Transition to Payroll Deduct

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This form is for members who wish to add a monthly donation and/or switch from credit card to payroll deduct. To become a member click here.

First Name *

Last Name *

Employee Number *

New Hire Designation

I was hired less than 13 months ago.

Only select this if your date of hire was fewer than 13 months ago and you also wish to defer monthly deductions.

Additional Monthly Contribution

If you wish to give more than the monthly minimum, submit that additional amount here.

Authorization for Payroll Deduction of Membership Dues *

I hereby authorize my employer to deduct my minimum membership dues and any additional donations as indicated above from my paycheck each month and forward it to the G4 Pilot Assistance Fund, inc. I understand that: This deduction will continue until I notify either the G4 Pilot Assistance Fund or my employer, in writing, of my intent to cancel it. AND Membership dues are not refundable once deducted. AND The amount deducted may be adjusted from time to time based on my current seat position (e.g., Upgrading to Captain or Downgrading to First Officer) or the G4 Pilot Assistance Fund’s minimum required donation levels. AND Canceling this authorization may affect my eligibility to receive assistance from the Fund.

Todays Date

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