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2020-2021 EARLY ENROLLMENT
MEMBERSHIP APPLICATION

Your Local Association/ Utah Education Association/ National Education Association

Membership dues vary by local. Connect with your UniServ Director, Local President or Building Leader for a summary of membership. 

This application is payroll deduction only. For additional methods of payment connect with your UniServ Office.

 

GENDER


RACE (optional)**









**Race – Race information is optional and failure to provide it will in no way affect your membership status, rights or benefits in NEA, UEA or any of their affiliates. This information will be kept confidential.
 
 
 
 
 
***Telephone Consumer Protection Act (TCPA) Consent – By providing my phone number, I understand that the National Education Association and its affiliates including the Utah Education Association, the local association, NEA Member Benefits and NEA360 may use automated calling techniques and/or text message me on my cellular phone on a periodic basis. The National Education Association, the Utah Education Association and the local association will never charge for text message alerts. Carrier message and data rates may apply to such alerts. Text STOP to 787753 to stop receiving messages. Text HELP to 787753 for more information.

EMPLOYMENT STATUS*



 

I AM




POSITION (major assignment)











YES! I want to be a NEW MEMBER. As a participant in the local association, Utah Education Association and National Education Association Early Enrollment Membership Incentive Plan, I am eligible to receive—prior to September 1, 2020, but in no event before April 1, 2020—benefits under the NEA Educators Employment Liability (EEL) Program, as well as access to select NEA Member Benefits Programs.

YES! I want to REJOIN. I am a previous member and wish to rejoin. As a participant in the UEA Early Enrollment Program (UEA EEP), I am eligible to receive–prior to September 1, 2020, but in no event before April 1, 2020 –certain benefits normally available only to regular dues-paying members of the Association, except for NEA/UEA USLP legal services only available to active members.

MEMBERSHIP STATUS*


 
YES to annual Payment Authorization - As a condition of eligibility for these benefits, I agree to pay the appropriate unified Active membership dues for the 2020-21 membership year in accordance with established payment procedures. I understand my obligation to pay that annual dues obligation continues, regardless of my membership status, and that if I fail to pay those amounts, my eligibility to receive benefits under the NEA EEL Program/UEA EEP shall immediately terminate. In addition, I shall become liable for the cost of any benefits that were provided to me under the NEA EEL Program/UEA EEP prior to September 1, 2020.

The District is hereby authorized and directed to deduct the specific sum certified by UEA or its designee, and to pay the dues to UEA or its designee by payroll deduction. I may revoke this dues deduction authorization by submitting a written directive to the District.

PAYMENT AUTHORIZATION*

 
By signing this application, I understand and agree: (1) membership is unified with the NEA, UEA and Local and I agree to the governing documents of each association; (2) membership is annual beginning September 1 and automatically renews annually thereafter; (3) membership dues may change from year to year but may not exceed three percent of my monthly salary; (4) dues may be paid monthly, however, the financial obligation for membership is an annual fee and any early cancellation will result in a dues obligation for the remaining portion of the year of membership; and (5) I hereby designate and empower the local association as my exclusive bargaining agent.

I UNDERSTAND THIS AGREEMENT IS VOLUNTARY AND IS NOT A CONDITION OF EMPLOYMENT AND THAT I HAVE THE LEGAL RIGHT TO REFUSE TO SIGN THIS AGREEMENT WITHOUT SUFFERING ANY REPRISAL.

 
 
 
I UNDERSTAND THAT CLICKING SUBMIT CONSTITUTES A LEGAL DIGITAL SIGNATURE CONFIRMING MY UNDERSTANDING AND AGREEMENT TO ALL OF THE TERMS ABOVE, AND MY CONSENT TO ENGAGING IN THIS TRANSACTION BY ELECTRONIC MEANS.