Membership Form

Affiliated with FEA, NEA & AFT

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First Name *

Middle Name

Last Name *

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Mailing Country *

Mailing Address *

Mailing Suite

Mailing City *

Mailing State *

Mailing Zip Code *

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Home Phone

Mobile Phone

Work Phone

Preferred Phones

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Personal E-mail *

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worksite *

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job title or classification *

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subject area *

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position *

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level *

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ethnicity (optional)

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gender (optional)

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Select your membership category

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Authorize

PAYROLL DEDUCTION AUTHORIZATION:

I hereby agree to pay, and authorize my employer to deduct the dues and assessments described above and as are certified by the Association to the School Board for each year thereafter from my salary and direct and authorize my employer to pay such amounts to the Association in accordance with payroll deduction procedures in effect; provided, however, I may cancel my membership and this authorization by providing 30 days' written notice to the School Board and the Association notifying them of such revocation as provided by law. However, if I receive a membership incentive (dues rebate or a "free months" promotion), I will not withdraw my membership during the first 12 months without reimbursing EA or Union of Escambia ESP for said incentives.

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