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Affiliated with FEA, NEA & AFT
personal-information-1
Last 4 Social Security Number
First Name
*
Middle Name
Last Name
*
billing-address
Mailing Country
*
United States of America
Mailing Address
*
Mailing Suite
Mailing City
*
Mailing State
*
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
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Hawaii
Idaho
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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
Date of Birth
Date
E.g., 2023-09-21
Home Phone
Mobile Phone
Work Phone
Preferred Phones
preferred
preferred
preferred
Personal E-mail
*
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worksite
*
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job title or classification
*
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subject area
*
subject area
Adult Basic Education
Agriculture
Architecture
Area Studies
Art
Biological Studies
Business
Communications
Computer Science
Driver Education
Education
Engineering
English/Language Arts
Fine & Applied ARts
Foreign Language & Lit.
Forestry
Geography
Health & Phys. Ed.
Health Professions
Fam & Consumer Science
Industrial ARt
Library Science
Mathematics
Military Science
Music
Physical Science
Psychology
Public Services Curric.
Reading
Science
Social Sciences
Social Studies
Special Education
Speech & Drama
Vocational Education
No subject Taught
General Subjects
Other
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position
*
position
Audio-Visual Technician
Cafeteria Worker
Classroom Teacher
Coach
Counselor
Custodian
Librarian
Maintenance Personnel
Office Support/Secretary
Principal/Asst. Principal
Speech Pathologist/Hearing Impaired
Supervisor/Director
Teacher Aide
Transportation Personnel
Other
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level
*
level
Preschool/Kindergarten
Elementary
Middle
High
Vocational Education
Central Site/Admin Center
Other
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ethnicity (optional)
ethnicity (optional)
American Indian/Alaska Native
Black
Hispanic
Caucasian (not of Spanish Origin)
Asian
Native Hawaiian/Pacific Islander
Unknown
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gender (optional)
gender (optional)
Male
Female
payroll-deduction
membership-wrapper
Select your membership category
Select your membership category
Escambia Education Association
Union of Escambia ESPs
privacy-policy
legal-wrapper
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.
Print your name
Date
Date
E.g., 2023-09-21
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