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7421 - Online Membership Form
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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 City
*
Mailing 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
Mailing Zip Code
*
personal-information-2
Home Phone
Mobile Phone
Work Phone
Preferred Phones
preferred
preferred
preferred
Personal E-mail
*
custom-field-1
School or Worksite
*
custom-field-2
GRADE & SUBJECT AREA or POSITION:
*
payroll-deduction
membership-wrapper
Select your membership category
Select your membership category
FCTA Dues
Dues Amount
$0.00
Total
* draft
privacy-policy
legal-wrapper
Authorize
PAYROLL DEDUCTION AUTHORIZATION:
As an FCTA member, I am eligible to receive benefits under the NEA Educators Employment Liability (EEL) Program as well as access to NEA/AFT/FEA Member Benefits programs. As a condition of eligibility for these benefits, I agree to pay membership dues for the remainder of the 2020-2021 membership year in accordance with established payment procedures. Should I fail to do so, my eligibility to receive benefits shall terminate immediately.
Print your name
Date
Date
E.g., 2023-09-21
Signature field is required
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Math question
*
2 + 16 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
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