association representative handbook - Alabama Education ...

Payroll Deduction Enrollment Form SampleALABAMA EDUCATIONASSOCIATION2012-2013PLEASE PRINT LEGIBLY AND PUT AN “X” IN ALL APPROPRIATE BOXES.SOCIALSECURITYNUMBER:LOCAL ASSOCIATION NAMEWORK LOCATION NAMENAME:FIRST M.I. LASTADDRESS:CITY: STATE: ZIP CODE:HOMEPHONE:((WORKPHONE:MEMBERSHIP TYPE: (PLEASE “X” ONE)q Active (full-time) q ESP (full-time) q StudentHOME Email:q Active (part-time) q ESP (part-time) q Reserveq Substitute q Associate q StaffWORK Email:((EXT.NUMBER:q Payroll Deduction___ ADMN Administrator*___ ATHL Athletic Director*___ PRIN Principal/Assist Principal*___ SINT Superintendent*___ SPRV Supervisor/Director*___ CUST Custodian___ GRND Groundskeeper___ MECH Mechanic/Repairer___ BGOT Bldgs/Grnd Main/RepairCrvs___ CLTR Classroom Teacher___ INSP Instructional Specialist___ COCH CoachPAY METHOD: (PLEASE “X” ONE)q Cash/CheckETHNIC INFORMATION (PLEASE “X” ONE)___American Indian/Alaska Native (1) ___Asian (6)___Black (3) ___Native Hawaiian/Pacific Islander (7)___Hispanic (4) ___Multi-Ethnic (8)___Caucasian/Not Spanish Origin (5) ___Other (9)___Unknown (UK)ASSOCIATIONAEANEALOCAL*ACT STATE $5.00*NEA FCPE*LOCAL VOTE(*Voluntary Contributions)TOTALDUES AMOUNTPOSITION CODES (PLEASE “X” ONE)___ CNSL Counselor___ PHTH Physical Therapist ___ SHTH Speech/Hearing___ COOK Cook/Food Prep Worker ___ PSYC PsychologistTherapist___ DIET Dietician/Diet Technician ___ READ Reading Specialist ___ CPSA Computer Prgm/Systm___ CSHR Cashier___ ROTC ROTC InstructorAnalyst___ FSSU Food Service Manager ___ BKPR Bookkeeper___ TECH Technician (Nonmedia/___ LPNU Licensed Practical Nurse___ RGNU Registered Nurse___ CAOA Clerk/Admin/Office AsstLibr)___ LIBR Librarian/Media___ RCOP Receptionist/Phone ___ MOAI Machine Oper/Assmblr/SpecialistOperatorInspctr___ OCCT Occupational Therapist ___ SEST Secretary/Stenographer ___ HVAC Plumber/HVAC___ LIAS Library Asst/ Technician ___ SCOT Secretary/Clerk/AdminMechanic___ SEDA Special Ed Assistant___ PPOT Paraprofessional/Aide___ SCWK Social Worker___ SDSP Special/Develop Ed___ BTVD Bus/Truck/Van Driver___ OTHR Other*Directly hires, evaluates, transfers, disciplines, or dismisses.MEMBER SIGNATURE DATE LOCAL ASSOCIATION REPRESENTATIVE SIGNATUREIMPORTANT: Please forward the white copy to AEA, P. O. Box 4177, Montgomery, AL 36103-4177. Forward the yellow copy to the payroll department,pink copy to the local association, and the gold copy is the member’s copy.The National Education Association Fund for Children and Public Education (NEA Fund) collects voluntary contributions from Association members and uses thesecontributions for political purposes, including, but not limited to, making contributions to and expenditures on behalf of friends of public education who are candidates forfederal office. Only U.S. citizens or lawful permanent residents may contribute to The NEA Fund. Contributions to The NEA Fund are voluntary; making a contributionis neither a condition of employment nor membership in the Association, and members have the right to refuse to contribute without suffering any reprisal. AlthoughThe NEA Fund requests an annual contribution of $15, this is only a suggestion. A member may contribute more or less than the suggested amount, or may contributenothing at all, without it affecting his or her membership status, rights, or benefits in NEA or any of its affiliates. Contributions or gifts to The NEA Fund are not deductibleas charitable contributions for federal income tax purposes. Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation,and name of the employer for each individual whose contributions aggregate in excess of $200 in a calendar year. Federal law prohibits The NEA Fund from receivingdonations from persons other than members of NEA and its affiliates, and their immediate families. All donations from persons other than members of NEA and itsaffiliates, and their immediate families, will be returned forthwith.*I understand that any contribution to A-VOTE or Local-Vote will be used to support candidates for local and state offices and are voluntary, given without coercion,and are not required as a condition of membership and that I have the right to refuse to contribute without any reprisal. The Association will not favor or disadvantageanyone for his or her decision not to contribute.Note**The total AEA membership amount for your membership category includes $36.00 for A-VOTE. If authorizing payroll deduction and you do not want the $36.00deducted, you must notify your payroll office in writing. This request can be made at anytime during the membership year. Dues payments and contributions to NEAFCPE, A-VOTE and Local Vote are not deductible as charitable contributions for federal income tax purposes. Dues payments (or a portion) may be deductible asa miscellaneous itemized deduction. Federal law requires political committees to report the name, mailing address, occupation and name of employees for eachindividual whose contributions aggregate in excess of $200 in a calendar year.Payroll Deduction: I authorize my employer to deduct from my salary and pay, in accordance with the agreed-upon payroll deduction procedure, the professional duesas established annually and political contributions indicated above for 2012-2013 membership year and every year thereafter provided that I may revoke thisauthorization for a succeeding membership year by giving written notice to that effect to my local association and school business office on or before September 15 ofthat year. If employment is terminated, amounts still owed under this authorization shall be deducted from my final pay due.39