Become a Member membership sign up Membership Sign-Up "*" indicates required fields First Middle Last Address Street Address Address Line 2 City STATEAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code LOCAL ASSOCIATION LAST 4 DIGITS OF SSN CELL PHONEWORK PHONEHOME PHONEPERSONAL EMAIL ADDRESS *By providing my cellular phone number, I understand that NEA and its affiliates including NSEA, Washoe Education Association, NEA Member Benefits, and NEA 360 may use automated calling techniques and/or text message me on my cellular phone on a periodic basis. NEA, NSEA and Washoe Education Association will never charge for text message alerts. Carrier message and data rates may apply to such alerts. Text STOP to stop receiving messages. Text HELP for more instructions.EMPLOYER POSITION TITLE WORK LOCATION SHIFT(please describe in hours-i.e. 3-11pm) HOURS WORKED PER DAY MONTHS PER YEAR MEMBERSHIP TYPE Full Time Part Time METHOD OF PAYMENT Payroll Cash * The information requested in the next box is optional and failure to answer it will in no way affect your membership status, rights or benefits in NEA, NSEA, or your local association.Gender Male Female Non-Binary Agender Androgynous Bigender Demiboy Demigirl Genderfluid Genderqueer Two-Spirit Prefer not to say Other Birth Date MM slash DD slash YYYY Ethnic Code American Indian/Alaska Native Native Hawaiian/Pacific Islander Asian Hispanic Black Caucasian Other Registered Voter Yes No Party Affiliation Democrat Republican Independent Non-Partisan Prefer Not to Say Other NSEA Together in Politics (NSEA-TIP) Authorization for Payroll Deduction The NSEA-TIP collects voluntary contributions from Association members and uses those contributions for political purposes, including, but not limited to, making contributions to and expenditures on behalf of friends of public education who are candidates for state office. Making a voluntary contribution is neither a condition of employment nor membership in the Association, and members have the right to refuse to make a voluntary contribution without suffering any reprisal. A member may voluntarily contribute any amount or may voluntarily contribute nothing at all without it affecting his or her membership status, rights, or benefits in NEA or any of its affiliates. Contributions or gifts to NSEA-TIP are not deductible as charitable contributions for federal income tax purposes.NSEA TIP Contribution Yes, I want to make a voluntary contribution NSEA-TIP Contribution Amount* per paycheck as a payroll deductionSignature*Date* MM slash DD slash YYYY NEA Fund for Children and Public Education Authorization for Payroll Deduction The National Education Association Fund for Children and Public Education (NEA Fund) collects voluntary contributions from Association members and uses these contributions for political purposes, including, but not limited to , making contributions to and expenditures on behalf of friends of public education who are candidates for federal office. Only U.S. Citizens or lawful permanent residents may contribute to the NEA Fund. Contributions to The NEA Fund are voluntary; making a contribution is neither a condition of employment nor membership in the Association, and members have the right to refuse to contribute without suffering any reprisal. Although the 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 contribute nothing at all, without it affecting his or her membership status, rights, or benefits in NEA or any of its affiliates. Contributions or gifts to t he NEA Fund are not deductible as charitable contributions for federal income tax purposes. Federal law requires political committees to report the name, mailing address, occupation and name of employer for each individual whose contributions aggregate in excess of $200 in a calendar year. Federal law prohibits t he NEA Fund from receiving donations from persons other than members of NEA and its affiliates, and their immediate families. All donations from persons other than members of NEA and its affiliates, and their immediate families, will be returned forthwithNEA Fund for Children and Public Education Contribution Agreement Yes, I will contribute money to the NEA Fund for Children and Public Education How much would you like to contribute to the fund?*per pay check as a payroll deduction for this purpose.Signature*Date* MM slash DD slash YYYY WEA Together in Politics (WEA-TIP) Authorization for Payroll Deduction I want to make an important investment in my future by contributing to the WEA Together In Politics Fund to support local candidates and campaignsI will contribute the below dollar amount per month to the WEA TIP Fund. per month to the WEA TIP FundPAYMENT I authorize Washoe County School District to deduct from my pay in each pay period a pro rata portion of the annual dues, fees, and assessments required for membership in the Washoe County Education Association, the Nevada State Education Association and the National Education Association, and any contribution amount authorized above for NSEA-TIP and/or NEA Fund for Children and Public Education, in accordance with the agreed-upon payroll deduction procedure. I fully understand that the annual dues, fees and assessments required for membership in the three associations are subject to periodic change by the governing bodies of the associations and authorize the Washoe County School District to deduct any modified monthly dues, fees, and assessments established by the governing bodies of the three associations, unless my obligation to do so ends under one of the circumstances set forth below. This authorization continues from year to year, regardless of my membership status, unless (a) I revoke this authorization in a signed writing sent to the address below between July 1 and July 15 of the membership year immediately preceding the membership year for which the authorization is to be revoked, or as otherwise designated by the negotiated agreement; or (b) my employment with the Washoe County School District ends. SignatureDate MM slash DD slash YYYY Association Agent SignatureDate MM slash DD slash YYYY Dues are not deductible as charitable contributions for federal income tax purposes. Dues may be deductible as a miscellaneous itemized deduction. 1890 Donald Street, Reno, Nevada 89502 NEA DUES-TAB beneficiary registration Form NEA DUES-TAB Insurance is an automatic benefit for eligible NEA members. please help us administer this program by giving us information on your beneficiary and by completing this form in its entirety. This Information will be held in strict confidence. Thank you. PLEASE PRINT YOUR NAME Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Select your beneficiary for the NEA DUES-TAB death benefit Survivng spouse(at time of death) Survivng children(divided equality) Survivng parents Estate Other NAME RELATIONSHIP (ifIt is a long established fact that a reader will be)I am currently an: Active Life Reserve Staff Life memebers must be activily empolyed in the field of education.Marital status Single Married Separated,Divorced,Widowed Are you the major wage earner in your houholder? Yes No About the same Gender Male Female If married,what is the employment status of your spouse ? Education employee Unemployed Other Professional Homemaker Student Executive White-collar Worker Blue collar Worker Other Retired Total family income $19,00 or below $20-29,999 $30-39,999 $40-49,999 $50-59,999 $60-69,999 $70,000 Number of children dependent on you for support of their year of birth 0 1 2 3 4 or moreNumber of children dependent on you for support of their year of birth First child DOB 2nd child DOB 3rd child DOB 4th child DOB Which statament best describes your housing situation ? Rent living quarters Own house Own mobile Own condominium Live with relative Other I have been a continuous NEA member since theschool years. school years.By signing this form, I verify that i am a member in standing of the National Education Association.SignatureDate Signed MM slash DD slash YYYY
