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First Name Middle Name (Optional) Last Name

Date of Birth Pronouns (Optional)

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Postal Code City State/Province

Preferred (non-work) Email (2) Home Phone Mobile Phone

Okay to text me. (1)

(1) By checking this box, I understand that the National Education Association and its affiliates including the Oregon Education Association, 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. The National Education Association, the Oregon Education Association and the local Association will never charge for text message alerts. Carrier message and data rates may apply to such alerts.

(2) Member email addresses are stored in a database shared by the National Education Association, OEA, and local affiliates. Email lists are not sold, leased, or rented to any other organizations.

Remember me so that I can use FastAction next time.

(Optional)

Membership Confirmation

MEMBERSHIP COMMITMENT: YES – I want to join with my fellow employees and become a member of the local association, the Oregon Education Association, 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.

ANNUAL PAYMENT AUTHORIZATION: YES – I hereby agree to pay the annual (Sep. 1 – Aug. 31) dues, fees, and assessments established by the three associations in consideration for the services the union provides. I understand that those annual amounts are subject to periodic change by the governing bodies of the associations. I authorize on a continuing basis, and regardless of my membership status, the payment of those annual amounts established by the three associations through payroll deduction unless I revoke this authorization in a signed writing sent to the President of the Oregon Education Association (6900 SW Atlanta St. Portland, OR 97223) via U.S. mail, between September 1 and September 30 of the membership year for which the authorization is to be cancelled

I UNDERSTAND THAT THIS AGREEMENT IS VOLUNTARY AND IS NOT A CONDITION OF EMPLOYMENTAND THAT I HAVE THE LEGAL RIGHT TO REFUSE TO SIGN THIS AGREEMENT WITHOUT SUFFERING ANY REPRISAL.

I Agree

I agree to Membership Commitment

I Agree

I agree to Annual Payment Authorization

Asserted Name (Optional)

Last 4 digits of your SSN

Employer Name

Local Association

School/Worksite

Occupation/Job Title/Position Title

Membership Category

Year Entered the Profession

Race

APPLICANT SIGNATURE: Typing your full name and date constitutes your legal signature, verifying that all information entered on this form is true and accurate to the best of your knowledge.

Today's Date

* I understand that checking this box constitutes a legal digital signature confirming my understanding and agreement to all of the terms above, and my consent to engaging in this transaction by electronic means.

I agree

FURTHER YOUR IMPACT - Make a voluntary donation! Donations to the OEA-PAC and OEA Foundation are tax-deductible!

Oregon Education Association Political Action Committee (OEA-PAC) collects voluntary contributions from members to support recommended candidates in state elections. 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 candidates for federal office. Only U.S. citizens or lawful permanent residents may contribute to The NEA Fund. Federal law prohibits The NEA Fund from receiving donations from persons other than members of NEA and its affiliates, and their immediate families. Contributions or gifts to OEA-PAC and The NEA Fund are not deductible as charitable contributions for federal income tax purposes. Contributions will be deducted for the current membership year and for each membership year thereafter in accordance with the payroll deduction procedure. Per dues deduction month equals the number of monthly payroll dues deductions in your local association contract.

Established in 1995, the OEA Foundation provides educators with up to $100 grants to help students meet basic, urgent and immediate needs so they can succeed in school. Cash grants from the Foundation fill needs unmet by any other source. The key source for these critical grants has been donations from OEA members and staff. The OEA family continues to be generous in their support through payroll deductions and cash and online donations. The Oregon Education Association funds all of the administrative costs of the Foundation, which allows all donations to be used to provide direct assistance to students.

I’m contributing to OEA-PAC and the NEA Fund ($50 single or $100 married filing jointly tax credit!) (Optional)

I'm contributing annually to the OEA Foundation! (Optional)

I'm contributing monthly to my Local PAC (Beaverton EA, Eugene EA, and Portland AT members only) (Optional)

Optional Paper Mail Opt-Out

In an effort to reduce your carbon footprint, would you like to opt-out of receiving any physical mailings from the Oregon Education Association? Please note, OEA cannot guarantee that you will no longer receive physical mail from your local association or from the National Education Association.

Paper Mail Opt-Out (Optional)

Yes, please do not send paper mail to me.