WISCONSIN EDUCATION ASSN COUNCIL

Support Staff Association

2013-2014
o I choose ELECTRONIC FUNDS TRANSFER
Name: Home Phone:
Work Location Name:
Member ID:
Address:
City, State Zip:
Alternate Phone:
Home Email:
Alternate Email:

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Check Number
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Account Number
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Routing Number
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$5
$72
$15
$10
$187
$110.5
Local Dues
WEACPAC
WEAC Dues
Membership Type/Fund/Obligation:
NEA: AC-2-100
SEA: AC-2- 100
LEA: AC-2-100
Electronic Funds Transfer - Bank Draft Authorization
Outstandin Balance: $ 399.50 # of Deductions: 12 Deduction Amount: $ 33.29
Bank Name:
Account Type: D Checking
.
D Savings
Bank Routing Number
(9 digits):
Bank Account Number:
PLEASE ATIACH A VOIDED CHECK TO THIS FORM
Signature: Date:
** LEGAL DISCLAIMER LANGUAGE IS LOCATED ON THE REVERSE SIDE OF THIS FORM
eDues will begin on Sept 10, 2013. If possible, please attach a VOIDED CHECK for verification of bank
information.
If I have chosen electronic funds transfer, I hereby authorize the Wisconsin Education Association Council
(WEAC) to transfer from my bank account the amount indicated above for the payment of my annual dues. If I
have chosen payroll deduction, I hereby authorize my employer to deduct dues in the amount indicated above
from my salary and remit to WEAC for so long as I am employed unless I revoke it in writing prior to August 1
of any school year. In the event there is a final judicial determination that 2011 Act 10's repeal of payroll
deduction is lawful , I hereby authorize WEAC to initiate electronic funds transfer from my bank account.
If I have chosen payroll deduction, I hereby authorize the Wisconsin Education Association Council
(WEAC) to initiate electronic funds transfer from my bank account indicated above for the payment of
my annual dues, in the event there is a final judicial determination that 2011 Act 10's repeal of payroll
deduction is unlawful. My authorization is in full force and effective until I terminate this agreement by
notifying WEAC in writing. I understand my written notification to WEAC must be made by the 1st day
of the month in order for this agreement to be changed in any manner or be terminated in that month.
The amount of my monthly payment is my annual dues obligation divided by 12 months (Sept.-Aug.). I
further agree that if any such withdrawal is dishonored with cause, WEAC shall be under no liability
whatsoever if such a dishonor results in late charges or fees
Terms and Conditions: By signing this application I understand and agree that A) membership is annual
beginning Sept 1; B) membership is for an entire year and renews annually thereafter; C) membership dues
are approved annually by the Representative Assembly and may change from year to year; and D) if I wish to
discontinue my membership I must do so in writing to the WEAC prior to the start of any membership year and,
in doing so, I will also forfeit my membership in the national , regional, and local affiliates and lose the rights,
privileges and benefits of membership. I hereby authorize EFT to the WEAC the annual dues for the current
membership year and each year thereafter on or before Sept 10.
I understand that my membership makes WEAC possible and entitles me to participate in union decisions and
activities, and that as a paying member I enjoy all rights and privileges guaranteed by the union constitution,
I may request a refund of that portion at my payment designated for political activity by writing to the WEAC
President, PO Box 8003, Madison WI 53708 between Sept 1 and Oct 30, or within 60 days of joining. This
Information is published annually. Your membership will not be affected by a request for refund.
The NEA Fund for Children and Public Education (NEA FCPE) is a political action committee subject to
regulation by the Federal Election Commission. The NEA FCPE is funded solely by voluntary member
contributions, not dues, and is used primarily for making contributions to and expenditures on behalf of
candidates for federal and state office. Only members of NEA and its affiliates, end their immediate family
members, who are U.S. citizens or lawful permanent residents, may contribute to the NEA FCPE,
Contributions to the NEA FCPE are not deductible as charitable contributions for federal income tax purposes.
Law requires the union to use our best efforts to collect and report name, address, occupation and employer
for each individual whose contributions aggregate is in excess of $200 in a calendar year.