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PSJA AFT Membership Application
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personal-information-1
Last 4 Social Security Number
First Name
*
Middle Name
Last Name
*
billing-address
Billing Country
*
United States of America
Billing Address
*
Billing Suite
Billing City
*
Billing 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
Billing Zip Code
*
personal-information-2
Date of Birth
Date
E.g., 2024-12-04
Mobile Phone
Preferred Phones
preferred
Personal E-mail
*
custom-field-1
Work Location
*
Work Location
ADMINISTRATION
Alamo Middle Schoo
Anaya Elementary Schoo
Arnold Elementary
Austin Middle School
Ballew College, Career & Technology Academ
Buell Central DAEP
Cantu, Sr. Elementary
Carman ElementarY
Cesar Chavez Elementary
Clover Elementary
Collegiate High School Program
Doedyns Elementary
Early College High School
Early Head Start Campus
Early Start Pre-K School
Escalante Middle School
Escobar Elementary
Farias Elementary
Ford Elementary
Garcia Elementary
Garza Elementary
Garza-Peña Elementary
Guerra Elementary
Kelly-Pharr Elementary
Kennedy Middle School
LBJ Middle School
Liberty Middle School
Livas Elementary
Long Elementary
Longoria Elementary
McKeever Elementary
Memorial Early College High Schoo
Murphy Middle School
North Early College High School
Palacios Elementary
Palmer Elementary
Ramirez Elementary
Reed & Mock Elementary
Sorensen Elementary
Sotomayor Early College High School
Southwest Early College High Schoo
Thomas Jefferson T-STEM Early College High School
TRANSPORTATION
Treviño Elementary
Vela Middle School
Yzaguirre Middle School
custom-field-2
Employee ID
*
membership-payment
membership-wrapper
Select your membership category
Select your membership category
Certified
Non-Certified
Dues Amount
$0.00
Total
* draft
Payment Methods
bank draft
credit/debit card
account type
Credit Card Types
Visa
Master Card
Discover
American Express
Name on Card
Card Number
Card Expiration Date
Month
-Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
-Year
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
Card Security Code
Where Is My CVV Number?
For most cards the Card Security code is printed on the signature strip on the back of the credit card. The value will be the last 3-4 digits of the printed number.
account type
Bank Account Types
checking
saving
Bank Name
Routing Number
Account Number
privacy-policy
legal-wrapper
Authorize
I agree to be a member of PSJA AFT, authorize PSJA AFT 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 PSJA AFT - Local 06597 and the American Federation of Teachers (AFT) to deduct dues for membership per the above information and in accordance with the PSJA AFT - Local 06597 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 PSJA AFT - Local 06597. I agree this authorization remains in effect until terminated in writing by me or until PSJA AFT - Local 06597 is given written notification of my separation from my employer and/or the bargaining unit.
Print your name
Date
Date
E.g., 2024-12-04
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Math question
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