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ACCAFT Membership Form
personal-information-1
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
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
Washington
West Virginia
Wisconsin
Wyoming
Mailing Zip Code
personal-information-2
Date of Birth
Date
E.g., 2019-02-19
Home Phone
Mobile Phone
Preferred Phones
preferred
preferred
Personal E-mail
*
Work Location
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Opt-in for text message alerts
Opt-in for text message alerts
Yes
No
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Employee Position
Employee Position
Full Time Faculty
Adjunct Faculty
Professional-Technical
Classified
Hourly
membership-payment
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Select your membership category
Select your membership category
$38.75 monthly Full Time Faculty
$28.88 monthly Classified-Prof Tech
$22.71 monthly Adjunct more than $12K
$17.83 monthly Adjunct $12K or less
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
$5
$8
$10
other
Other Amount
Payment Methods
bank draft
account type
Bank Account Types
checking
saving
Bank Name
Routing Number
Account Number
privacy-policy
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Authorize
Electronic Dues Payment
I authorize ACCAFT to draft my bank account for the monthly amount listed on this application in single monthly payments. The monthly dues amount may change if required by local, state or national constitutions. I authorize my bank to adjust my monthly payment when notified by ACCAFT. This authorization remains in effect until terminated in writing by me. These deductions will continue for this school year and future years, including any increases in dues, until terminated by me in writing.
Authorize COPE
COPE electronic payment
This authorization is signed freely and voluntarily and not out of any fear of reprisal, and I will not be favored or disadvantaged because I exercise this right. I understand this money will be used to make political contributions by ACCAFT COPE. ACCAFT COPE may engage in joint fundraising efforts with the TEXAS AFT, AFT and AFL-CIO. A voluntary COPE authorization may be revoked at any time by notifying ACCAFT in writing of the desire to do so. Texas law prohibits ACCAFT from contributing general dues dollars to political campaigns. Contribution or gifts made to ACCAFT COPE are not deductible as charitable contributions for federal income tax purposes. Contributions cannot be reimbursed or paid by any other person or entity.
Print your name
Date
Date
E.g., 2019-02-19
Leave this field blank