MEPA Membership 2018-2019
Email address *
MEMBERSHIP DUES ARE $8.00. DEADLINE TO JOIN FOR PAYROLL DEDUCTION IS OCTOBER 1 - FOR CASH OR PERSONAL CHECK THE DEADLINE IS OCTOBER 31ST, 2018
After October 31, 2018, only employees new to the district may apply for membership
First Name *
Your answer
Last Name *
Your answer
Employee ID *
Your answer
Campus or Department *
Work Extension *
Your answer
EmailAddress *
Your answer
Position Held *
Payment Method *
If you are paying by CASH or CHECK please give the money to your campus/department liaison in an envelope with your NAME and CAMPUS/DEPARTMENT on the outside of the envelope.
Please DO NOT send CASH through inter-district mail.
Payroll Deduction Authorization
My name printed below authorizes the Mesquite Independent School District to deduct the total amount of $8.00 in order to pay for 2018-19 MEPA Membership. The number of pay periods per year over which the deduction shall be made is ONE. Upon termination of my employment, I authorize any unpaid balance to be deducted from my final check. YOU WILL NOT BE REIMBURSED FOR CANCELLATIONS. PAYROLL DEDUCTION DEADLINE IS OCTOBER 1st, 2018. IT WILL BE TAKEN OUT OF YOUR OCTOBER 26TH, 2018
My name typed below is my authorization for payroll deduction for MEPA 2018-19 dues. *
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Mesquite ISD. Report Abuse - Terms of Service - Additional Terms