Membership Enrollment Form – Join IEA

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Membership Enrollment

1 Membership

2 Employment

3 Dues

4 Personal Information

5 Interest

6 Authorization

Membership Information
- 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?*
- 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)
- NEA Classification
- SEA Classification
- NEA Start Date
  Date Format: MM slash DD slash YYYY
- SEA Start Date
  Date Format: MM slash DD slash YYYY

Employment
- Employer*
- Local Association Name*
- Worksite
- IEA Region
- Billable Party ID
- Employer User ID
- Worksite User ID
- Position Category
- Position Name
- Teaching Subject Category
- Teaching Subject
- Teaching Subject (Higher Ed)
- Associate Staff
- Associate Staff Email
- President Contact Email
- President Contact Email 2
- Local Membership Contact Email
- Local Membership Contact Email 2
- Dues Month
- Dues Day
- Dues Next Month

Dues Information
- NEA Dues First Half
- NEA Dues Second Half
- NEA Dues
- IEA Dues First Half
- IEA Dues Second Half
- IEA Dues
- IPACE
- Local Dues
- NEA Fund for Children & Public Education
- IEA Crisis Fund
- Total Dues
- (This 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.

Personal Information
- First Name*
- Middle Name
- Last Name*
- Suffix
- Maiden Name
- Address*
  Street Address Address Line 2 City State ZIP Code
- Primary Address
- Personal Email*
  Enter Email Confirm Email
- Primary Email
- *Cell Phone*
- Primary Phone
- Last 4 digits of your Social Security Number
- 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.

Interests in Issues
- As an educator, you have a close-up view of the opportunities and challenges facing our schools. These questions will help us provide the support you and your school need most.
- Our association provides support and tools to ensure your success with students. What tools/trainings would you like to hear more about?
  - Classroom management (e.g. student behavior, relationships with students)
  - Lesson planning
  - Working with mentors/coaches
  - Working with families
  - Collaborating with administrators and colleagues
  - Unpacking professional expectations (e.g. evaluations, observations)
- Our association works to ensure every school provides our students with the opportunities to succeed. Which of the following issues are most important to you?
  - Social and racial justice
  - Meeting the needs of students in poverty
  - Family and community engagement
  - Fully funded schools
  - Education policy – Contribution to critical decisions affecting my students, school and district
  - Political advocacy – Supporting education policies to ensure all students have opportunities to succeed
- Our association advocates for conditions that retain high-quality educators for all students. Which of these are you interested in learning about?
  - Salary
  - Educator rights and responsibilities
  - Health care benefits
  - Pensions and retirement security
  - Student debt and/or finances
  - Stretching your paycheck
  - Working conditions

Authorization
- Membership Commitment*
  I want to join my fellow employees and become a member of the local association, the Illinois Education Association-NEA, and the National Education Association. I hereby request and voluntarily accept membership in these associations and agree to abide by the Constitution and Bylaws of all three associations.
  Yes! I agree
- Annual Payment Authorization*
  I hereby agree to pay the annual (Sept. 1 – Aug. 31) dues, fees and assessments established by the three associations in consideration for the services the union provides and hereby authorize my employer (including any other employer to which my employment is transferred by law or agreement) to deduct from my pay such dues, fees and assessments, as well as voluntary contributions to Illinois Political Action Committee for Education (IPACE), as these sums are annually established, and to NEA Fund for Children and Public Education (NEA FCPE), and/or voluntary contributions to IEA Crisis Fund, to forward such amounts to my local association (or IEA-NEA, if the local association is no longer affiliated with IEA-NEA). I understand that those annual amounts are subject to periodic change by the governing bodies of the associations. I authorize on a continuing basis, regardless of my membership status, the payment of those annual amounts established by the three associations through payroll deduction [or check] unless (a) I revoke this authorization in a signed writing sent to the IEA President at the following address: 100 E. Edwards St., Springfield, IL 62704 via U.S. Mail by Sept. 15 of the current membership year for which the authorization is to be cancelled or b) my employment ends.
  Yes! I agree
- 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*
  Date Format: MM slash DD slash YYYY
- {all_fields}
Phone
This field is for validation purposes and should be left unchanged.

© 2020 Illinois Education Association · 1-844-432-1800

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