MEMBERSHIP ENROLLMENT FORM CERTIFICATED
CTA MEMBERSHIP DEPARTMENT COPY Continue on the back side
Thank you for choosing a career in education. While it’s personally rewarding, it’s also professionally demanding.
That’s why NEA, CTA and your local association will provide you the support you need to be great at what you do.
Being a member connects you with other educators. Together, we’ve been the most powerful voice for students and
public education in California since 1863. And together, we still are. We do this by:
NEA FUND DEDUCTION AUTHORIZATION (Optional)
I agree to contribute $________ annually to the NEA Fund. The NEA
Fund for Children and Public Education (NEA Fund) collects voluntary
contributions from Association members and uses these contributions 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 o ce. ** See reverse for more information.
PERSONAL INFORMATION MEMBERSHIP INFORMATION
Negotiating fair salaries, health care and other bene ts
Leading student-centered educational improvements
Supporting your professional practice with conferences, workshops,
grants and scholarships
Improving learning and working conditions
Enhancing and defending your professional rights
Providing cost-saving bene ts designed just for educators
TEACHING ASSIGNMENT INFORMATION
AND DUES CATEGORY
61% - 100%
25% or less
33 1/3% - 50%
26% - 33 1/3%
51% - 60%
Adult Ed Hourly
All CTA dues include a $20 voluntary contribution per year to help
fund CTA advocacy e orts and fund the CTA Foundation for Teaching
and Learning, which provides scholarships to members and supports
teacher-led e orts to improve public schools. To opt out of the voluntary
contribution, complete a Voluntary Contribution Change Form. Forms
are available at www.cta.org/contribution, from your local membership
contact or via email at email@example.com.
Local Association _______________________________________________
School District _________________________________________________
Hire Date _________________________ Primary Employer? Yes No
If no, list employer ______________________________________________
Job Title _______________________________________________________
Building/Work Site ______________________________________________
MEMBERSHIP, DUES PAYMENT AND DUES DEDUCTION AUTHORIZATION
YES, I want to join with my fellow employees and be
a committed member of the Local Association, the California Teachers Association (CTA), and the National
Education Association (NEA). I hereby request and voluntarily accept membership in these associations and agree to abide by the Constitution and Bylaws of all
three associations, as they may be amended from time to time. I support the Local Association in its role as my exclusive representative in collective bargaining
over wages, hours, and other terms and conditions of employment.
I hereby (1) agree to pay annual dues uniformly required for membership in the Local, CTA, and NEA; and (2) request and authorize my Employer to deduct from
my pay in each pay period, and transmit to CTA or its designated agent, a pro rata portion of the annual dues required for membership in the Local, CTA, and NEA,
unless I pay dues by check. I fully understand that the dues required for membership in the three associations are subject to periodic change by the associations’
governing bodies and authorize dues payment on a continuing basis, and regardless of my membership status, unless my obligation to do so ends under one
of the circumstances below. This agreement to pay dues continues from year to year, regardless of my membership status, unless: I revoke it by sending written
notice via U.S. mail to CTA Member Services, P.O. Box 4178, Burlingame, CA 94011, not less than thirty (30) days and not more than sixty (60) days before the annual
anniversary date of this agreement; my employment with the Employer ends; or as otherwise required by law.
I understand that this agreement is voluntary and is not a condition of employment and that I have the legal right not to sign this agreement.
Your Advocate. Your Partner. Your CTA.
YEAR 20___ - 20___
FOR OFFICE USE ONLY
ANNUAL DUES AMOUNTS
NEA FUND: ____________
TOTAL: $ ______________
CTA VOLUNTARY CONTRIBUTION
CTA/ABC & INDEPENDENT EXPENDITURES ALLOCATION (Optional)
Designated portions of CTA dues are allocated to the Association for Better
Citizenship (CTA/ABC) and to Independent Expenditures (IE) through which CTA
provides nancial support for education-related issues (CTA/ABC) and CTA-
endorsed bipartisan candidates for local and state o ces (CTA/ABC and IE).
Please indicate if you choose not to allocate a portion of your dues to
the CTA/ABC and the IE account and want all your dues to remain in the
CTA Membership ID or Previous Employer/School District
First Name __________________________________________ MI ___________
Last Name ___________________________________________________________
Last 4 of SSN _________________________________________________________
Home Address _______________________________________________________
________________________________________________ Apt _______________
State ___________________ Zip ______________________________________
Land Line ___________________________________________________________
Cell Phone* __________________________________________________________
Home Email _________________________________________________________
* See next page for information
I agree to the above Terms & Conditions.