3821 MEA Online Membership Form

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First Name *

Middle Name

Last Name *

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Mailing Country *

Mailing Address *

Mailing City *

Mailing State *

Mailing Zip Code *

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Personal E-mail *

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Title *

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Home Phone

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Mobile Phone *

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Plan of Payment *

Cash

Payroll Deduction

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Employee ID *

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Nickname or Preferred Name

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Position, Subject, and Grade Level

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School Name *

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Recruiter

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Select your membership category

Dues Amount

$0.00

Total * draft

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Authorize

I hereby authorize the District School Board, Manatee County, according to arrangements agreed upon with the Manatee Education Association, to deduct from my salary and transmit to said unit such dues and assessments as are annually certified by said unit.

I hereby waive all rights and claims to said monies so deducted and transmitted in accordance with this authorization and relieve the School Board and all its officers from any liability therefore. This authorization shall remain in full force and effect for all purposes while I am employed by this district, or until revoked by me in writing upon thirty (30) days written notice to the School Board and said unit. I understand that all such dues and assessments are strictly voluntary. Contributions or gifts to the MEA are not deductible as charitable contributions for federal Income tax purposes; however, under limited circumstances, dues may qualify as business expense.

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