Personal Information

First Name *

Last Name *

Phone Number *

PERSONAL e-Mail Address *

Re-enter PERSONAL eMail Address *

Street Address *

City *

State *

Zip Code *

Optional Survey Data

How did you hear about Educators First?

Ethnicity

Gender

Other Political Party

Political Affiliation

Employment Information

School *

School System *

Title/Position *

Are you Certified? (ALL certificate types) *

Grade/Subject *

What is your experience in years? *

Employment Status *

Are you currently facing any disciplinary action? 🛈

Membership Information

Please indicate your membership preference: *

Full Membership - Pay Dues Upon Application

Student membership (not an employee)

Referring Member Name

Which EF Representative assisted you? *

Event Code:

Select your Membership Level * 🛈

Certified Membership - Monthly - $32.50/mo

Certified Membership - Annual - $358 (BD or CC only)

First year Certified (no teaching experience) - Monthly - $16.25/mo

First year Certified (no teaching experience) - Annual - $179 (BD or CC only)

Classified Membership - Monthly - $16.25/mo

Classified Membership - Annual - $179 (BD or CC only)

Student Teacher (not an employee) - $9.95/yr, (BD or CC only)

How will you pay your dues? Add your personal payment information in this section. *

Employee Monthly Payroll (PDD) (When you select this button, IF SSN or ID box does not appear below, choose other payment method.)

Bank Draft

Credit Card

PAYROLL DEDUCTION

Do NOT select PDD if the SSN or ID box does not appear for your payment info OR if you are a student teacher

Social Security #

Employee ID #

BANK DRAFT PAYMENT

Bank Name *

Account Type *

Routing # *

Account # *

CREDIT CARD PAYMENT

Name on Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

By signing below, you are stating that you understand and agree to the statement above and agree to pay the dues appropriate to your choice of membership level.

I hereby authorize the above school system/bank/credit card company to deduct the full amount of my annual organizational dues in 12 equal monthly payments, or as otherwise specified. Each monthly payment includes a refundable contribution of up to $1/month to the bi-partisan Educators First PAC. To remove myself from the voluntary PAC, I will contact the Educators First office in writing. I understand that the above rates are subject to change on an annual basis. I understand that I have signed a contract to pay the total amount due for the entire 12 month membership year, and for each year hereafter, until I terminate my membership in writing with at least 60 days paid in advance notice, after completing the first year. I also understand that certain membership benefits may not begin until after my first dues payment has cleared. Paid membership includes defense attorney coverage provided by the network attorney for covered employment related matters, including suspension or termination hearings. Some exclusions may apply. Paid membership also includes; non-attorney representation in local disciplinary matters, assistance with complaints, grievances, rebuttal letters, evaluation appeals, general employment advice, bi-partisan advocacy, and expert consultations regarding all personnel matters. I understand that the terms of my membership require that I act professionally and in good faith, while reasonably performing my duties within the the scope of my employment. Pre-existing conditions, prior incidents, malicious criminal acts, willful wrong-doing, or intentional misconduct, may result in reduced defense attorney coverage. Educators First does not discriminate on the basis of race, color, gender, marital status, sexual preference, religion, national origin, age, disability, or as otherwise prohibited by law. Educators First reserves the right to refuse or cancel membership for any lawful business reason. I understand that I must contact my district’s payroll department directly should I choose to cancel any ongoing payroll deductions for other organizations, and that Educators First is not allowed to cancel my memberships to other organizations. *Annual membership dues are paid in advance. ** “First Year Teachers” includes brand-new teachers with less than 1 year of teaching experience.

Please sign here using your mouse, finger, or stylus (depending on device). * 🛈

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