Active ESP

Educational Support Professional
WVEA/NEA/LEA 2014-2015
1558 Quarrier Street
Charleston, WV 25311
304.346-4325 fax

Please fill out, print and fax or mail the registration form below.

(last, first, m.i.)
City, State, Zip: ,
Phone: ( ) -
Social Security
- -
Date of Birth: / /
Local Name/
Employer Name/
Work Location

Registered Voter: Yes
Political Party:

Check the column that applies to you:

Support (ESP)



NEA Dues
LEA Dues

* Inclusive - Combined Teacher & ESP Local
** Teacher Only - No administrators accepted in local
(suggested $15.00)
(suggested $10.00)
(suggested $10.00)
Method of Payment:
Cash (CA)
Bill Me (CI)
Payroll (PR)

MasterCard (MC)
Card Number:
Exp. Date: / /

Signature: ________________________________

Visa (VISA)
Card Number:
Exp. Date: / /

Signature: ________________________

I choose to be a continuing member of WVEA, NEA, and my local Association, and I hereby authorize my employer to deduct from my salary and remit to WVEA, in accordance with the agreed upon payroll deduction procedure, unified membership dues, as may be determined from time to time, and political action contributions as indicated above, for the 2014-2015 membership year and every membership year thereafter, provided that I may revoke this authorization as of September 1 of any calendar year by giving written notice to that effect to my employer and WVEA on or before that date.

The National Education Association Fund for Children and Public Education (NEA-FCPE) collects contributions from Association members and uses those contributions to help elect friends of education to federal office. The West Virginia Education Association Political Action Committee (WVEA-PAC) performs a similar function in connection with elections to state office. Contributions to NEA-FCPE and WVEA-PAC are voluntary and are not a condition of membership in NEA, WVEA, or any of their affiliates. Although NEA-FCPE and WVEA-PAC request an annual contribution of $15 and $10, respectively, these are only suggestions. A member may contribute more or less than the amount suggested or may refuse to make any contribution and this will not affect his or her membership status, rights or benefits in NEA, WVEA, or any of their affiliates. You must be a member of NEA if you wish to contribute to NEA-FCPE and a member of WVEA to contribute to WVEA-PAC.

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.

In accordance with the WVEA Bylaws, a WVEA contribution of nine dollars ($9.00) for WVEA-PAC and one dollar ($1.00) for the Ballot Initiative Fund (BIF) has been accessed as part of the WVEA dues. Any person wishing not to participate in WVEA-PAC or BIF should contact the WVEA office prior to November 1. Where objections are made, the member may choose to: (a) divert the ten dollars to the West Virginia Foundation for Improvement of Education, or (b) receive a rebate of either one or both of the assessments. Where objections are made the assessments will not be used for political purposes or ballot initiative purposes. If you wish to contribute to NEA-FCPE or to make an additional contribution to WVEA-PAC, or your local PAC, write the amount of your contribution in the appropriate box marked with an (*).

Dues payments are contributions to NEA-FCPE and WVEA-PAC are not deductible as charitable contributions for federal income tax purposes. Dues payments may be deductible as a miscellaneous itemized deduction.

Signing this form constitutes a binding contract to pay annual dues except by following the conditions set forth in the "continuing membership" statement above.

Member's Signature ________________________________

Date: ____/ ____/ _____

County Employee ID number: ________________________________

Retain a copy for your records.