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AFT 6101 Boone Membership Application
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personal-information-1
Last 4 Social Security Number
First Name
*
Middle Name
Last Name
*
billing-address
Billing Country
*
United States of America
Billing Address
*
Billing Suite
Billing City
*
Billing State
*
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
US Virgin Island
Washington
West Virginia
Wisconsin
Wyoming
Billing Zip Code
*
also mailing address
Mailing Country
*
United States of America
Mailing Address
Mailing Suite
Mailing City
Mailing State
mailing state
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
US Virgin Island
Washington
West Virginia
Wisconsin
Wyoming
Mailing Zip Code
personal-information-2
Home Phone
Mobile Phone
Work Phone
Preferred Phones
preferred
preferred
preferred
Personal E-mail
*
Employer
Worksite Location
custom-field-1
Employment Status
*
Employment Status
Full- Time
Part-Time
Substitute or On-Call
custom-field-2
Who referred you to AFT? (please list name and their worksite)
membership-payment
membership-wrapper
Select your membership category
Select your membership category
full-time professional - teacher, counselor, nurse
part-time or substitute professional
unpaid leave of absence
Dues Amount
$0.00
Total
* draft
COPE Amount
By donating to COPE, we’re able to fight for your pension, good legislation, and elected officials who support you and your professions. Donating to COPE is the most effective way for your voice to be heard.
COPE Amount Values
$0
$1.00
$2.00
$5.00
other
Other Amount
Payment Methods
bank draft
credit/debit card
account type
Credit Card Types
Visa
Master Card
Discover
American Express
Name on Card
Card Number
Card Expiration Date
Month
-Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
-Year
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
Card Security Code
Where Is My CVV Number?
For most cards the Card Security code is printed on the signature strip on the back of the credit card. The value will be the last 3-4 digits of the printed number.
account type
Bank Account Types
checking
saving
Bank Name
Routing Number
Account Number
privacy-policy
legal-wrapper
Authorize
I agree to be a member of AFT Boone County Federation of Teachers, authorize AFT Boone County Federation of Teachers to represent me to the fullest extent of the law, and accept the terms of the agreement below.
I authorize deduction of membership dues per the above information and in accordance with my local affiliate, the constitutions of AFT and AFT-WV. Dues payments are not deductible as charitable contributions for federal income tax purposes, but a portion thereof may be deductible as a miscellaneous itemized deduction. The dues amount may change if authorized according to the provisions of the local, state, or national affiliate’s constitutions, or if my employment status changes. If this happens, I authorize my bank or credit card to adjust my payment when notified by the AFT-WV. I agree this authorization remains in effect until terminated in writing by me. A portion of my membership dues goes to the AFT-WV Committee on Political Education (COPE) for use in local and state political activities. This amount is automatically included in the membership dues; however, the contribution is voluntary. Any member who does not wish to make this voluntary contribution may file a written request to AFT-WV between August 1 and August 31 for a refund of the contribution for the preceding year.
Authorize COPE
I have read and agree to make the voluntary COPE contribution as described below.
COPE DISCLOSURE: I herby authorize an additional voluntary monthly contribution to the COPE as selected below. This authorization is signed freely and voluntarily and not out of any fear of reprisal, and I will not be favored nor disadvantaged because I exercise this right. My contribution goes to the AFT-WV COPE for use in local and state political activities. This voluntary authorization may be revoked at any time by notifying AFT-WV in writing of the desire to do so. COPE contributions cannot be reimbursed or otherwise paid by any other person or entity and are not deductible as charitable contributions for federal income tax purposes.
Print your name
Date
Date
E.g., 2024-12-03
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Math question
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