OEA Foundation Payroll Deduction Form

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Your Information

First Name Middle Name (Optional) Last Name

Date of Birth

Street Address

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)

Monthly Payroll Deduction

Annual contributions will be divided equally per dues deduction month and deducted each pay period for the current membership year and for each membership year thereafter in accordance with the payroll deduction procedure. Members may change or terminate contribution at any time by completing a new OEA Foundation Form and returning it to a UniServ office.

Employer

Local/Chapter

Worksite (Enter Full name of Building) (Optional)

Occupation/Job Title/Position

Asserted Name (Optional)

Last 4 digits of your SSN

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

I'm contributing the OEA Foundation!

YES, I would like to make a voluntary contribution to the OEA Foundation in the amount of $10 per dues deduction month

YES, I would like to make a voluntary contribution to the OEA Foundation in the amount of $5 per dues deduction month

Other monthly amount ($5 Min per dues deduction month)

In Honor or Memory of: (Optional)