OEA Online Membership Form

1 YOUR INFORMATION
Employer
Employment Type

Employment Type Certified Classified
Worksite
Local/Chapter
Job Title
Work Email
Last Name
First
Middle
Preferred Name
Date of Birth
Mailing Address
City
State/Province
Postal Code
Paper Mail Opt-Out¹
Cell Phone²
Home Phone
Non-Work Email³
Self-Reported Ethnicity

Self-Reported Ethnicity Alaska Native/American Indian Asian Black Latinx Multi-racial Native Hawaiian/Pacific Islander Other White Prefer not to answer
¹To reduce my carbon footprint, I opt out of receiving paper mail from the Oregon Education Association (OEA). (OEA cannot guarantee that you will not receive physical mail from your local association or the National Education Association (NEA). ²By providing my cell phone number, I understand that the National Education Association and its affiliates, including [state association], the local association, NEA Member Benefits and NEA360, may use automated calling techniques and/or text message me on a periodic basis. These entities will never charge for text message alerts. Carrier message and data rates may apply to such alerts. ³Non-Work emails are stored in a database shared by NEA, OEA, and local affiliates, and are not sold.
2 VERIFY

(Both boxes must be checked in order to confirm membership and dues authorization.)
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 EMPLOYMENT AND THAT I HAVE THE LEGAL RIGHT TO REFUSE TO SIGN THIS AGREEMENT WITHOUT SUFFERING ANY REPRISAL.
3 SIGNATURE
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
ELECTRONIC SIGNATURE DISCLAIMER: 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.
4 Make a Voluntary Donation

To help cover processing costs, we kindly suggest a minimum of $5 per month


	$20	$10	Other
My OEA-PAC (per dues deduction⁴ month) nonpartisan contribution:	My OEA-PAC (per dues deduction⁴ month) nonpartisan contribution:$20	My OEA-PAC (per dues deduction⁴ month) nonpartisan contribution:$10	My OEA-PAC (per dues deduction⁴ month) nonpartisan contribution:Other

Enter other OEA-PAC nonpartisan contribution amount: $ Dollars . Cents


	$20	$10	Other
My OEA Foundation (per dues deduction⁴ month) tax-deductible contribution:	My OEA Foundation (per dues deduction⁴ month) tax-deductible contribution:$20	My OEA Foundation (per dues deduction⁴ month) tax-deductible contribution:$10	My OEA Foundation (per dues deduction⁴ month) tax-deductible contribution:Other

Enter other OEA Foundation tax-deductible contribution amount: $ Dollars . Cents


	$10	$5	Other
My NEA Fund (per dues deduction⁴ month) nonpartisan contribution:	My NEA Fund (per dues deduction⁴ month) nonpartisan contribution:$10	My NEA Fund (per dues deduction⁴ month) nonpartisan contribution:$5	My NEA Fund (per dues deduction⁴ month) nonpartisan contribution:Other

Enter other NEA Fund nonpartisan contribution amount: $ Dollars . Cents
My Local PAC (per dues deduction month⁴) nonpartisan contribution (For Beaverton, Eugene, and Portland Locals only): $ Dollars . Cents
⁴ Per dues deduction month equals the number of monthly payroll dues deductions in your local association contract.

Oregon Education Association Political Action Committee (OEA-PAC) and The NEA Fund for Children and Public Education collects contributions from Association members for political work. This includes, but is not limited to, making contributions to (and expenditures on behalf of) friends of public education who are candidates for office. Only U.S. citizens or lawful permanent residents may contribute to OEA-PAC and 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 to the Funds are voluntary. Making a contribution is neither a condition of employment nor membership in the NEA, OEA, or local association, and members have the right to refuse to contribute without suffering any reprisal. A member may contribute more or less than the suggested amounts, or may contribute nothing at all, without it affecting their membership status, rights, or benefits in NEA or any of its affiliates.

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. Federal law requires the NEA Fund to use best efforts 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.
SIGNATURE: Type your full name
Today's Date

OEA Online Membership Form

1 YOUR INFORMATION

2 VERIFY

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

3 SIGNATURE

4 Make a Voluntary Donation