Membership Application

Personal Info

Work Info

Membership Info

PAC Info

Finish

* denotes a required field

Personal Info

Legal Name

Prefix

First Name *

M.I.

Last Name *

Suffix

Contact Information

Street Address Line 1 *

Street Address Line 2

City *

State *

Zip Code *

County *

Home Email Address *

Confirm Home Email Address *

Primary Phone Number

Primary Phone Type: *

Cell Phone

Home Phone

Secondary Phone Number

Secondary Phone Type: *

Cell Phone

Home Phone

Other Information

SSN Last 4 *

Birthday *

Nickname

Previous Last Name

Gender

Race/Ethnicity

Preferred Pronouns

PIC Number (if applicable)

Have you been an MEA member before? *

Yes

Work Info

Work Information

Are you employed at more than one district? *

Yes

Which district do you work for? *

Which building do you work in? *

Which job classification best represents your work? *

Dues Start Date *

Work Email

Work Phone Number

Work Extension

Membership Info

Dues Payment Information

Information on dues amounts, which are subject to change each year, is available at https://mea.org/dues-information/

I will work with my local to set up dues payments

All Inclusive Membership (AIM) In MEA/NEA-Retired

All members of MEA/NEA are automatically enrolled in MEA/NEA-Retired unless the box below is checked. The AIM fee is in addition to MEA/NEA dues.

I do not wish to join MEA/NEA-Retired at this time. I understand that I will not be eligible for any of the benefits of membership in MEA/NEA-Retired.

PAC Info

MEA-PAC & NEA Fund for Children and Public Education

CONTINUING AFFIRMATIVE CONSENT AUTHORIZATION

All education decisions are political decisions. That's why many MEA members make voluntary contributions to MEA-PAC and the NEA Fund, which are used to support pro-public education candidates (your dues dollars cannot be and are not used for contributions to political candidates).

Would you like to make voluntary contributions to MEA-PAC & NEA Fund for Children and Public Education? *
This optional contribution is not related to MEA membership/dues.

Yes

Not at this time

Finish

Terms, Conditions, and Signature

I have read and agree to the

Enter your legal name *

By My Signature, I indicate that I have read, understand and agree to the terms of this Agreement. I acknowledge that I have not been subject to any duress, intimidation, threats, or coercion in the execution of this Agreement. By typing my name or any other symbol or mark that I intend to represent as my electronic signature in the signature box above, I am agreeing to conduct this transaction by electronic means, and it is my intent to sign this Agreement electronically.

Additional Information

Who helped you complete this application?

Check all that apply

MEA UniServ Director/Executive

Other MEA Staff

Local Officer

Another MEA Member

Is there anything you'd like us to know?

0 / 175