2016-2017 Student Membership Rebate Application
For a PDF of the form listed below- click here
Mail before May 1, 2017 to:
NEA Membership Records ATTN: Student Rebates
1201 - 16th Street, N.W.
Washington, DC 20036-3290
SOCIAL SECURITY NUMBER: _______ - _______ - _______ (We MUST have this number)
FORMER LAST NAME, IF APPLICABLE: _________________________________
CITY, STATE, ZIP __________________________________________
I certify that 2016-2017 is my first year of Active membership eligibility and I am an NEA Active member.
My Local Affiliate is: ______________________________________
My State Affiliate is: ______________________________________
Below is a record of my former Student membership:
COLLEGE OR CHAPTER & STATE
YEAR(S) A MEMBER
SIGNATURE: ________________________________ DATE: _______________