SFABSE SFUSD Employee Membership Form

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San Francisco Alliance of Black School Educators Membership Form

Email *

SFUSD Email *

First Name *

Middle Name

Last Name *

Home Address *

City *

State *

Zip Code *

Mobile Number *

SFUSD Work Site *

SFUSD Role *

Administrator

Teacher

Counselor

Paraprofessional

Classified / Clerical

Classified / Other

Community Member

Retiree

Parent

Organization / Business

N/A

Other:

Employee ID

Membership Level - Payroll Deduction

$300.00 per year ($25.00 per month) - Administrators

$240.00 per year ($20.00 per month) - Teachers

$120.00 per year ($10.00 per month) - Classified

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Payroll Deduction: Pursuant to state law and current agreement between the District and SFABSE, all non-SFUSD employees may SFABSE. Dues are paid by payroll deduction and forwarded to the SFABSE each month.

SFABSE Membership: Entitles members to attend meetings, vote and hold office and participate in SFABSE programs.

Authorization for Dues Withholding from Earnings

I hereby request and voluntarily authorize my employer to deduct from my earnings and pay over to SFABSE the regular monthly dues uniformly applicable to members of SFABSE. This authorization will remain in effect and shall be irrevocable unless I revoke it by sending written notice to SFABSE during the period not less than 30 days and not more than 45 days before 1) the annual anniversary date of this agreement or 2) the date of termination of the applicable contract between the employer and SFABSE, whichever occurs sooner. This authorization shall be automatically renewed as an irrevocable check-off from year to year unless I revoke it in writing during the window period, irrespective of my membership in SFABSE.

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