CSEC - LC Membership Form

Classified School Employees Council of Las Cruces

2010-2011

(Please Print Clearly)                                                                                                                                                                

 School/Worksite                                                                 

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Social Security Number                           (Ms.  Mrs.  Mr.)                       First Name                     Last Name

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Address                                                                   City                                       State                   Zip Code

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Home Phone           Cell Phone               Work Phone                       Job Title            Home E-Mail Address

OPTIONAL:  Ethnicity:  Native American ___   Hispanic ___   Asian/Pacific Islander ___  Caucasian ___     Black ___   Other ___   

I agree to pay regular membership dues through the 2010-2011 school year.

_____ Earnings more than $12,000/yr        10-11 payroll deduction is $13.26 per pay period

_____ Earnings less than $12,000/yr           10-11 payroll deduction is $7.67 per pay period

_____ Nutrition Service Workers                  10-11 payroll deduction is $4.87 per pay period

I hereby agree to authorize my employer to deduct from my salary in accordance with the agreed upon payroll deduction procedure for my membership dues as revised annually and voluntary political action contribution in the amount of $3.00 for the current membership year and each membership year thereafter, provided that I may revoke this authorization after September 1, 2011 by giving written notice to that effect to the local Association on or before October 6, 2011 or any subsequent year.  If for any reason, excepting death, my employment is terminated, amounts still owing under this authorization shall be deducted from final pay due.                             

The voluntary $3.00 contribution for political action may be refunded to members who request it according to procedures contained in the NEA-NM Bylaws.  Forms for requesting the refund are available at www.nea-nm.org and are published twice annually in the Advocate’s Voice.              

I hereby join the Classified School Employees Council - Las Cruces (CSEC-LC).  I understand that by joining CSEC-LC I am also joining, and my continuing dues payment(s) include membership in the NEA, NEA-NM, AFT, AFT-NM and AFL-CIO subject to their policies, guidelines, regulations and any related agreements between them now or in the future regarding CSEC-LC joint memberships and affiliations.

AFT-NM Voluntary Political Donation:  I further agree to pay in cash or through employer payroll deduction an annual contribution of $_________ to AFT-NM COPE (committee on political education).  I understand that membership in good standing in my local and AFT-NM is not dependent upon my decision to contribute or not to contribute to AFT-NM COPE.  Contributions are not deductible for Federal Income Tax purposes.

Member’s Signature                                                                                   Date                                              

CSEC-LC Member/Recruiter ________________________________________ Date _________________________

 For Office Use Only

Received:                                    NEA:                     AFT:                     LCPS:                    CSEC-LC List:                 Worksite List:        

Please Give to Your CSEC-LC Council Representative OR Send Via School Mail to Marcia Brown at Cesar Chavez Elementary