NATIONAL
EDUCATION
ASSOCIATION
MEMBERSHIP ENROLLMENT FORM CERTIFICATED
CTA MEMBERSHIP DEPARTMENT COPY Continue on the back side
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Union
Labor
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
Category 1
61% - 100%
Category 3A
25% or less
Category 2A
33 1/3% - 50%
Category 3B
26% - 33 1/3%
Category 2B
51% - 60%
Category 4
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 membership@cta.org.
Local Association _______________________________________________
Current Employer/
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___
Associate
FOR OFFICE USE ONLY
ANNUAL DUES AMOUNTS
NEA: _________________
CTA: __________________
LEA: __________________
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
general fund.
CTA Membership ID or Previous Employer/School District
_____________________________________________________________________
First Name __________________________________________ MI ___________
Last Name ___________________________________________________________
Last 4 of SSN _________________________________________________________
Home Address _______________________________________________________
________________________________________________ Apt _______________
City ________________________________________________________________
State ___________________ Zip ______________________________________
Land Line ___________________________________________________________
Cell Phone* __________________________________________________________
Home Email _________________________________________________________
* See next page for information
I agree to the above Terms & Conditions.
Name/Signature ___________________________________
Date _________________________
DEMOGRAPHIC INFORMATION (Optional)
Ethnicity
African American
American Indian/
Alaska Native
Asian
Caucasian
Hispanic
Multi-Ethnic
Native Hawaiian/
Paci c Islander
Other
Unknown
Female
Male
Non-Binary
HOW CAN WE BEST SUPPORT YOU? (Optional)
Gender Birthdate __________________________
(mm/dd/yyyy)
2. I am:
MORE INFORMATION
*By providing my phone number, I understand that the NEA and its a liates including CTA, the Local, NEA Member Bene ts, and
NEA360 may use automated calling technologies and/or text message me on my cellular phone on a periodic basis. NEA and its
a liates will never charge for text message alerts. Carrier message and data rates may apply to such alerts. Text STOP in response
to an NEA, CTA or Local text message to stop receiving the association’s messages.
**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 su ering any reprisal. Although the NEA Fund requests an annual contribution of $50, this is only
a suggestion. A member may contribute more or less than the suggested amount, or may contribute nothing at all, without it
a ecting his or her membership status, rights or bene ts in NEA or any of its a liates. Contributions to the NEA Fund are not
deductible as charitable contributions for federal income tax purposes. Federal law requires political committees to report the
name, mailing address, occupation, and name of employer for each individual whose contributions aggregate in excess of $200 in
a calendar year.
Membership Enrollment Form Revised 052819
1. What year did you enter the profession? _________________
Social Media Used:
Instagram
Facebook
Pinterest
Twitter
Already a member
Interested in receiving more information about membership
Transferring from another district
Joining the Association today
Classroom management (e.g. student
behavior, relationships with students)
Lesson planning
Working with mentors and coaches
Working with families
Collaborating with administrators and colleagues
Unpacking professional expectations
(e.g. evaluations, observations)
3. Your association provides supports and tools to ensure your
success with students. What tools/trainings would you like to
hear more about?
4. Your association works to ensure that schools provide students
with opportunities to be successful. Which of the following
issues are most important to you?
Social and racial justice
Meeting the needs of students in poverty
Education policy - Contributing to critical decisions a ecting
my students, school, and district
Family and community engagement
5. Your association advocates for conditions that retain
high-quality educators for every student. Which of these are
you interested in learning about?
Salary
Educator Rights & Responsibilities
Health Care Bene ts
Pensions and Retirement Security
Student Debt and/or Finances
Stretching Your Paycheck
Working Conditions
Political advocacy - Supporting education policies to
ensure all students have opportunities to succeed
Fully funded schools
CALIFORNIA TEACHERS ASSOCIATIONCALIFORNIA TEACHERS ASSOCIATION
Welcome to CTA!
We are so happy to welcome you to your local chapter, the California Teachers Association, and the
National Education Association. Whether you are new to the profession, new to the district, or just new to
CTA, we want you to know that we are here to support you and empower you to be the best educator and
advocate you can be. While education is a calling, it’s also a vital job and a rewarding career, and when we
all work together in union, we build a stronger profession.
Its our union and our voice that ensures every student in California gets the public education they deserve,
regardless of ZIP code. That’s why CTA supports and advocates for the educators who are nurturing
tomorrow’s inventors, thinkers, artists and leaders.
With CTA, you’ll never be on your own. There’s always a fellow member not far away who is willing to give a
helping hand, some sage advice, or a shoulder when you need it.
Be sure to visit our websites regularly to learn about happenings locally and statewide, and check
your home email for important messages and involvement opportunities. Visit www.CTA.org to learn
about statewide activities and resources available to members. www.CTAGo.org has information about
professional development opportunities and incentive grants for members to attend CTA conferences.
Lastly, visit www.CTAMemberBene ts.org to take advantage of all the discounts and bene ts available
exclusively to you as a member of the California Teachers Association.
Again, welcome to CTA. We are so glad you joined.
1705 MURCHISON DRIVE, BURLINGAME, CA 94010 • P.O. BOX 921, BURLINGAME, CA 94011-0921
650.697.1400
• WWW.CTA.ORG
MORE INFORMATION
*By providing my phone number, I understand that the NEA and its a liates including CTA, the Local, NEA Member Bene ts, and
NEA360 may use automated calling technologies and/or text message me on my cellular phone on a periodic basis. NEA and its
a liates will never charge for text message alerts. Carrier message and data rates may apply to such alerts. Text STOP in response
to an NEA, CTA or Local text message to stop receiving the association’s messages.
**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 su ering any reprisal. Although the NEA Fund requests an annual contribution of $50, this is only
a suggestion. A member may contribute more or less than the suggested amount, or may contribute nothing at all, without it
a ecting his or her membership status, rights or bene ts in NEA or any of its a liates. Contributions to the NEA Fund are not
deductible as charitable contributions for federal income tax purposes. Federal law requires political committees to report the
name, mailing address, occupation, and name of employer for each individual whose contributions aggregate in excess of $200 in
a calendar year.
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