CONTACT INFORMATION
Name Title
Organization Email
Address City State Zip
Office Phone Cell Phone
Professional Liability Insurance
Professional Liability Insurance is open to K-12 employees and certain governmental entities. Insurance runs concurrent
with membership year and goes into effect the date the membership is processed and paid. More information on the
coverage offered can be found on the Professional Educators Liability Insurance Policy Information Form located here:
tasbo.org/become-a-member/member-benefits
☐ Yes, I want to purchase the optional professional liability coverage for an additional charge of $45.
*Itemization of Insurance Fee: premium is $37, state taxes/fees are 5%, $1.85 and $6.15 is retained as a TASBO administrative fee.
Please Note: This form is for purchasing insurance and membership together. If insurance is purchased separately, then
use the Short-Term Member Insurance Registration Form.
Payment
Dues are up to a 12-month period, non refundable and will not be pro-rated. Benefits begin the day TASBO receives
payment of membership. *Purchase orders are not accepted for dues payment. Please do not email credit card info.
Total Amount $ ☐ Check Enclosed ☐ Credit Card #
Cardholder Exp Date Signature
Become a Member!
Form Effective November 1, 2020
SUBMIT: register@tasbo.org; fax: 512.462.1782; mail: 5920 W. William Cannon Dr., Bldg 1, Ste 200, Austin, TX 78749
PROFILE INFORMATION
Job Function Includes:
☐ Accounting & Finance ☐ Distribution & Inventory ☐ Information Technology ☐ Instructional Materials
☐ Internal Audit ☐ Maintenance & Operations ☐ Payroll ☐ PEIMS
☐ Personnel ☐ Purchasing & Supply Mgmt ☐ Safety, Security & Risk Mgmt ☐ School Nutrition
☐ Transportation
Please add me to the committee(s) that correspond with my job function: ☐ Yes
Additional Area of Interest: ☐ Governmental Relations
☐ Interested in
Volunteer Opportunities?
Employment Level:
☐
Senior Leadership
☐
Management
☐
Staff
☐
Consultant
☐
Retired
Certification Status:
☐ Currently seeking a TASBO Certification ☐ Have a certification and seeking a higher level
☐ Have a certification and taking CEUs to maintain ☐ Tell me more about certification ☐
Not currently interested
MEMBERSHIP | INSURANCE | PAYMENT
Member Type: (if there is a staff change at the district, membership can be transferred to another employee)
☐
K-12 Employee: $135
☐
Education Service Provider: $135
☐
Retired: $45
Open to any employee of
K-12 schools.
Open to employees of not-for-profit
organizations, higher education faculty/staff,
Regional Service Center employees and
employees of state governmental entities.
Open to those who retired from a K-12 or
ESP and are not otherwise employed by a
for-profit entity or serving as an independent
contractor for schools.
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