DASA Membership Application
DASA Membership Application
Title *
First Name *
Last Name *
Education Agency *
School Name/Agency Department *
Position
Clear selection
Business Address (include number & street, city, state, zip code) *
Office Phone *
Cell Phone
Email Address (District or Charter email preferred) *
Home Address (include number & street, city, state, zip code) *
DASA Membership ($355) is Required for Department Membership. Select the department you wish to join. *
Required
Enter Total Membership Dues Below ($355 plus department membership) *
With full knowledge of the above, I authorize my employer to deduct from my salary and pay to the association, in accordance with the agreed upon payroll deduction procedure, my association dues as may be determined from time to time as indicated above for the current membership year and each membership year thereafter, provided that I may revoke this authorization as of July 1 of any calendar year by giving written notice to that effect to DASA and my employer on or before June 30 of that year. Payment of Dues: *
Required
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