Membership Form -- AAUP -UI Chapter

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Today's date: *

YYYY

Name: *

Department: *

Personal E-mail: *

Rank: *

Home address: *

Monthly Dues: *

Please select the level of dues from the list below; monthly dues include national and chapter dues

$7.00 Faculty members with academic incomes of $30,000 or less

$8.50 Members with academic incomes of $30,001–$40,000

$10.59 Members with academic incomes of $40,001–$50,000

$12.59 Members with academic incomes of $50,001–$60,000

$16.59 Members with academic incomes of $60,001–$70,000

$19.09 Members with academic incomes of $70,001–$80,000

$21.17 Members with academic incomes of $80,001–$100,000

$23.09 Members with academic incomes of $100,001–$120,000

$25.25 Members with academic incomes of more than $120,000

Until further notice, I request monthly PAYROLL DEDUCTION for future dues payments. *

(If you prefer payment by check or credit card, please download, print and fill out the paper membership form linked to at the top of the page.)

Yes

Required

University ID *

Required to process payroll deduction request

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