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First Name
*
Middle Name
Last Name
*
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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
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Indiana
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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
*
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Personal E-mail
*
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Home or Mobile Number
*
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Date of Birth
*
Date
E.g., 2023-12-06
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Last 4 Digits of your Social Security Number
*
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EIN
*
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School Worksite with Position
*
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How did you hear about joining LCEA?
LCEA Website
Building Representative/worksite meeting
Colleague
Email/phone
Social Media
Flyer/bulletin board
Family member/Community member
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If a colleague referred you to join LCEA, please provide their name here.
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Select your membership category
Select your membership category
Membership
Dues Amount
$0.00
Total
* draft
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Authorize
I agree to be a member of Lake County Education Association, authorize LCEA to represent me to the fullest extent of the law, and accept the terms of the agreement below.
By providing the information on this form, I authorize LCEA 3783 and the American Federation of Teachers (AFT) to deduct dues for membership per the above information and in accordance with the Lake County Education Association - Local 03783 constitution, the state constitution and the AFT constitution. 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 requirements of the local, state or national constitutions. If this happens, I authorize my bank or credit card to adjust my payment when notified by LCEA. I agree this authorization remains in effect until terminated in writing by me or until LCEA is given written notification of my separation from my employer and/or the bargaining unit.
Print your name
Date
Date
E.g., 2023-12-06
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