Membership Enrollment Form

YES! I want to join with my fellow educators in my local union, IEA, NEA.
(Fields with a red asterisk * are a requirement for enrollment.)

Membership Year*

Enrollment Type*

Membership Number

Employee ID #

Employment start date*

First year employed in education*

Are you a former IEA Student Member?*

2024-2025 Projected Starting Annual Salary*

Enter your 2024-2025 projected starting annual salary.
Please note: if transferring from another IEA affiliated local and remaining in the same membership category, please enter your 2022-2023 creditable earnings as reported to the applicable retirement systems.

Is your Projected Starting Annual Salary correct? Please make changes or continue if correct.

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Creditable Earnings (Rounded)*

Classification*

Membership Type*

If you are unsure which to select please contact the Local President or Membership Contact.

Higher Education Contingent Faculty should select - Quarter-time (less than 10 hours)

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FY Classification Cert

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FY Classification ESP

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NEA Start Date

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SEA Start Date

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NEA Classification

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SEA Classification

Employer*

Local Association Name*

Worksite

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Billable Party ID

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IEA Region

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Employer User ID

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Worksite User ID

Position Category

Position Name

Teaching Subject Category

Leave blank if no subject taught.

Teaching Subject

Teaching Subject (Higher Ed)

Leave blank if no subject taught.

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Associate Staff

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Associate Staff Email

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Dues Day

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Dues Month

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Dues Current Day

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Dues Current Month

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Dues Next Month

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NEA Dues First Half

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NEA Dues Second Half

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IEA Dues First Half

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IEA Dues Second Half

NEA Dues

IEA Dues

IPACE

Local Dues

NEA Fund for Children & Public Education

IEA Crisis Fund

Total Dues

(The Total Dues amount does not include Local Dues.)

Payment Method*

IPACE STATEMENT: Contributions to IPACE of $30.00 may be used to support candidates for local or state office. A different amount may be established annually by IEA. These contributions are voluntary and not required as a condition of employment or membership in any organization. A refund of this amount may be obtained if written notification is given by the member to IPACE, 100 E. Edwards St., Springfield, IL 62704, prior to Dec. 31 of the current school year. IPACE refund request forms can be obtained from the IEA Government Relations Department. Contributions to IPACE are not deductible as charitable contributions for federal income tax purposes.

NEA FCPE STATEMENT: The NEA Fund for Children and Public Education (NEA Fund) collects voluntary contributions from association members which are used for political purposes, including, but not limited to, making contributions to and expenditures on behalf of friends of public education who are candidates for federal office. Only U.S. citizens or lawful permanent residents may contribute to the NEA fund. Contributions to the NEA fund are voluntary; making a contribution is neither a condition of employment nor membership in the association, and members have the right to refuse to contribute without suffering any reprisal. Contributions to the NEA fund are not deductible as charitable contributions for federal income tax purposes. Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation, and name of employer for each individual whose contributions aggregate in excess of $200 in a calendar year.

IEA CRISIS FUND STATEMENT: This IEA Crisis Fund provides direct financial assistance to help alleviate financial burdens incurred by members who are on strike. The IEA suggest that active members voluntarily contribute $2.00, or more, annually to the IEA Crisis Fund. Contributions to the IEA Crisis Fund are voluntary and are not required as a condition of employment or membership in any organization. You also may donate directly to the IEA Crisis Fund by visiting the IEA website at https://ieanea.org. Contributions to the IEA Crisis Fund are not deductible as charitable contributions for federal income tax purposes.

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President Contact Email

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President Contact Email 2

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Local Membership Contact Email

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Local Membership Contact Email 2

First Name*

Middle Name

Last Name*

Suffix

Maiden Name

Nickname

Do you use a PO Box?

NO

YES

PO Box

PO Box City State ZIP Code

Home Address*

YOUR LEGAL PLACE OF RESIDENCE

Street Address Address Line 2 City State ZIP Code

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Primary Address

Do not use a district or school email address

Personal Email*

DO NOT USE A SCHOOL OR DISTRICT EMAIL ADDRESS

Enter Email Confirm Email

ARE YOU SURE THIS IS A PERSONAL EMAIL ADDRESS? IF SO, PLEASE CONTINUE.

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Primary Email

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Work Email

*Cell Phone*

Last 4 digits of your Social Security Number

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Primary Phone

Date of Birth*

Ethnicity

Primary Home Language

Gender Identification

* By providing my phone number, I understand that the National Education Association (NEA) and its affiliates, including the Illinois Education Association-NEA (IEA-NEA), 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. I understand I can unsubscribe from receiving such messages by contacting IEAConnect at 1-844-432-1800. The NEA, IEA-NEA, and my local association will never charge for text message alerts. Carrier message and data rates may apply to such alerts.

I understand that 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.

Dues payments and contributions or gifts to IPACE, NEA FCPE and IEA Crisis Fund are not deductible as charitable contributions for federal income tax purposes.

The invalidity or unenforceability of any particular provision shall not affect the validity and enforceability of other provisions in this Agreement.

Digital Signature*

I understand that signing this box constitutes a legal digital signature confirming my understanding and agreement to the above.

Signature of*

Signature Date*

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Spanish

{First Name:2} {Last Name:4}