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Okeechobee County Education Association Membership Form
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First Name
*
Middle Name
Last Name
*
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Mailing Country
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United States of America
Mailing Address
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Mailing Suite
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Mailing State
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Mailing Zip Code
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Date of Birth
Date
E.g., 2023-12-06
Mobile Phone
Preferred Phones
preferred
Personal E-mail
*
Work E-mail
Work Location
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Position
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Last four digits of Social Security Number
*
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Ethnicity
Ethnicity
Asian
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White (not Hispanic origin)
Native Hawaiian/Pacific Islander
Other Racial or Ethnic Minority
Unknown
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Select your membership category
Select your membership category
Teacher Dues
ESP Dues
Dues Amount
$0.00
Total
* draft
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Authorize
The Okeechobee County Education Association is hereby designated as my agent to represent me with the Okeechobee County School Board.
I request and authorize the Okeechobee County School Board to deduct from my earnings and transmit to the organization an amount sufficient to provide for regular payment of membership dues as certified from time to time by the organization. I understand that such deduction is revocable upon thirty (30) days written notice to the employer and OCEA provided, however, that such deduction shall be in force so long as the employee organization remains the certified bargaining agent for employees in the unit. I hereby waive any rights and claims for said monies so deducted and transmitted in accordance with the organization and indemnify the board and its agents.
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Date
Date
E.g., 2023-12-06
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