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OCCTA - Membership Form
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First Name
*
Middle Name
Last Name
*
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Mailing Country
*
United States of America
Mailing Address
*
Mailing Suite
Mailing City
*
Mailing State
*
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Alabama
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Connecticut
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District of Columbia
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New York
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Ohio
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Pennsylvania
Rhode Island
South Carolina
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Tennessee
Texas
Utah
Vermont
Virginia
US Virgin Island
Washington
West Virginia
Wisconsin
Wyoming
Mailing Zip Code
*
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Date of Birth
Date
E.g., 2023-12-06
Home Phone
Mobile Phone
Work Phone
Preferred Phones
preferred
preferred
preferred
Personal E-mail
*
Work E-mail
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Employee ID
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Worksite
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Opt in for Text Messages
Yes
No
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Union Activists Needed! Check if you are interested in working for your union.
Being a part of the school or worksite leadership team
Membership and Organizing
Government Relations
Professional Development and Training
Human and Civil Rights
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Recruiter
payroll-deduction
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Select your membership category
Select your membership category
Instructional Full Time Dues
Instructional Part Time Dues
Dues Amount
$0.00
Total
* draft
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Authorize
I authorize and request Orange County School Board to deduct Orange County Classroom Teachers Association dues and assessments from my bi-weekly pay, and to transmit the deducted amounts to the Association office. I understand the School Board will discontinue dues deduction upon 30 days’ written notification to both the Association and Board.
I understand that dues, assessments, contributions or gifts to the OCCTA are not tax deductible as charitable contributions for federal income tax purposes although a portion of the dues may be tax deductible under other provisions of the Internal Revenue Code
Print your name
Date
Date
E.g., 2023-12-06
Signature field is required
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Math question
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