WVEA Retired 2021-2022 1558 Quarrier Street Charleston, WV 25311 Please complete, print and mail the registration form below with payment. Name (Last, First, MI) Email Address Mailing Address City, State, Zip Phone Number Social Security Number (last 4 digits) Date of Birth: Month/Day/Year County Retired From ANNUAL MEMBERSHIP Association Payment NEA $35.00 WVEA $15.00 SUBTOTAL: $50.00 Optional PAC: NEA/FCPE $___________ WVEA/PAC $___________ TOTAL: $___________ NOTE: If you retired prior to 9/1/73, you may change the NEA dues amount from $35 to $5, but only NEA. Suggested Optional PAC: $15 NEA-FCPE; $15 WVEA-PAC LIFE MEMBERSHIP Association Payment NEA $300.00 WVEA $100.00 SUBTOTAL: $400.00 Optional PAC: NEA-FCPE $___________ WVEA-PAC $___________ TOTAL: $___________ Suggested Optional PAC: $15 NEA-FCPE; $15 WVEA-PAC 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 $15, 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. Dues payments and 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. If you wish to contribute, please write your contribution amount in the boxes marked for NEA-FCPE and WVEA-PAC and total in the contribution amount column. Member's Signature ________________________________ Date: ____/ ____/ _____ Date of Retirement: Month/Day/Year Submit
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