Littleton Education Association - CEA - NEA Authorization for Membership and Salary Deduction - 2020-2021
Membership type *
Membership status (active teachers only) (If your FTE is not exactly 1.0 or 0.5, please also complete a Request for Partial Dues Reimbursement form) *
Social Security # (only last 4 digits) *
First name *
Middle initial *
Last name *
Street address (include Apt. #, if applicable) *
City *
Zip Code *
LPS school/site *
Are you a U.S. citizen? *
Home phone (xxx-xxx-xxxx)
Cell phone (xxx-xxx-xxxx) *
Initial here if you consent to NEA/CEA/LEA, NEA Member Benefits, &/or NEA360 contacting you via automated/prerecorded calls &/or text messages.
Home email address *
Birthdate (mm-dd-yyyy) *
Registered voter *
Party affiliation
Clear selection
Gender *
Ethnicity (check all that apply)
Position (check all that apply) *
Required
Subject (check all that apply) *
Required
Monthly amount - payroll deduction *
I authorize Littleton Public Schools to make such deduction from year-to-year in the amount certified by LEA for each year for LEA/CEA/NEA membership. I request membership in all three associations and agree to abide by the Articles and Bylaws of all three associations. All deductions from my salary for United Education Profession dues are to be promptly remitted to LEA in accordance with the procedures agreed to by the School District and LEA. If I desire to terminate my membership, I agree to notify LEA, in writing, August 1 - September 5. Dues deduction will cease with the September payroll. (Your typed name will serve as your electronic signature.) *
Date of signature *
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