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Membership Form
MEMBERSHIP FORM
Please fill out the form below.
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Last 4 Of Social Security # (THIS IS KEPT CONFIDENTIAL)
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First Name
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Middle Name
Last Name
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Address
Address Line 1
Address Line 2
City
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Tennessee
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Washington
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State
Zip Code
Personal Email
Work Email
Home Phone
Cell Phone
Birthday
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DD
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YYYY
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1921
1920
Ethnicity
Gender
US Citizen (See #4 Below)
Yes
No
Referred By WEA Member
Registered Voter
Yes
No
MEMBERSHIP
Multiple Choice
Republican
Democrat
Independent
Other
Membership Type
Active PreK-12 Educator
Active Education Support Professional (ESP)
Principal/Assistant Principal
Substitute
Other
School/Worksite
I Hold What Position
Subject Or Grade Level (If Applicable)
LOCAL ASSOCIATION
Westminster Education Association
DUES
Dues, 2023-2024 monthly deduction amount (Dues are yearly divided into 12-month deductions) check one
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Licensed Personnel
Educational Support Professionals
Licensed Personnel
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Full-time $86.07
Part-time $44.00
Full-time first year $54.12
Part-time first year $28.02
Check if you were a student member last year
Yes, I was a student member last year
Educational Support Professionals
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Full-time $39.23
Part-time $20.60
Full-time first year $26.01
Part-time first year $13.98
*ESP members working 1387.5 hours or more shall be considered full time.
WEA/CEA First-Time First Year Reduced Dues are available to those employees when it is your first year ever to be employed by any public school district in the U.S.
FUNDS
Select Method
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Payroll Deduction
Electronic Funds Transfer (EFT)
Westminster Public Schools, hereinafter referred to as “the District” is authorized and requested to deduct the sum stated above from each monthly salary check payable to me beginning after the date stated below.
The District will remit to the Westminster Education Association, hereinafter referred to as “WEA,” such deductions for the purposed of dues payment. I also understand the monthly amount to be deducted in future years will be certified by WEA to the District by August 15th annually as long as this authorization is in effect and Article 33 of the Licensed Agreement and Article 16 of the Educational Support Professionals Agreement between WEA and the District are in effect. I expressly agree that the District shall not be liable in any way for any oversight, omission or failure in the making of such remittance, or be under any obligation to see that dues receipt and application of said amount is paid
Name of Banking Institution:
Bank Routing #:
Bank Account #:
AUTHORIZATION
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Check to Confirm:
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I hereby authorize my monthly dues to be collected and paid to the Westminster Education Association, per my selection above.
I have reviewed this form in its entirety and hereby authorize the continuing payment or dues deduction of unified dues (local affiliate, CEA, NEA as applicable) unless I revoke this authorization in writing to WEA per bylaws Section V – Membership, which authorizes that I provide written notification to the WEA to cancel this authorization between June 1st and June 15th (see #1 on back of form).
IMPORTANT NOTES:
1. I understand my membership is voluntary. I fully understand that the annual association dues, fees, and assessments required for membership in the three associations are subject to periodic change by the governing bodies of the associations and authorize on a continuing basis the payment of the modified dues unless I revoke my membership in writing with the appropriate local association or I am no longer working with the school district.
2. I understand that I must maintain active and continuous membership to continue to receive membership benefits, legal services, and any other NEA or CEA products.
3. By providing my cell phone number, I understand and agree that CEA / NEA / NEAMB may use automated calling, prerecorded calls, and/or text me on a periodic basis. The three affiliates will never charge for text message alerts. Carrier message/data rates may apply. I understand that I can revoke my consent at any time.
4. The CEA Active full-time membership dues for teachers, building principals, and college faculty includes $41 Every Member Option (EMO) for political activities and $15 Public Relations Assessment for CEA’s advertising campaign. The CEA Active full-time membership dues for Education Support Professionals includes $20.50 EMO and $7.50 PR Assessment. EMO and the PR Assessment are pro-rated for part-time members.
The CEA will refund the EMO by check if the member notifies CEA in writing before December 15 by U.S. mail or email at the CEA website, coloradoea.org. CEA notifies all Active members who join after Dec 15 about EMO. Retired, Student, and Reserve members do not pay EMO or the PR Assessment, though they may make contributions to either or both. There is EMO refund information at coloradoea.org. Providing U.S. Citizen information is voluntary, it is collected in order to refund Every Member Option contributions to non-U.S. citizen members in accordance with Colorado law. Ethnicity information is optional.
5. If you work half-time or less, you will pay half dues. This is determined by your employment contract and by the threshold of 1387.50 hours for Educational Support Professionals. If an Active member joins after September 1, the local association must prorate the dues by the number of months remaining in the membership year. Retired and Student memberships are not prorated.
6. Dues payments are not deductible as charitable contributions for federal income tax purposes, but (a portion) may be deductible as a miscellaneous itemized deduction.
7. All information is confidential. WEA / CEA does not sell or give away member lists. Membership is open only to public education employees and students in pre-teaching programs at any public or private college/university.
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