NFA Member Application

NFA Membership Application

NSHE Full-Time Professionals
NFA is the independent association of faculty in Nevada since 1983, affiliated with the American Association of University Professors ("AAUP") and the American Federation of Teachers ("AFT"). We work to empower faculty to be fully engaged in our mission to help students succeed. We advocate for academic freedom and faculty employee rights. For further information: http://www.nevadafacultyalliance.org/

NOTE: This application form is for NSHE professional employees at 0.5 FTE or higher. For part-time faculty, retirees, and other individuals not eligible for payroll deduction, please use our Partners and Allies Application.

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Applicant Information
Name*

First NameLast Name
Institution*
Approver*
example@example.com
Department*
Mobile/Personal Phone Number
*By providing my cellular phone, I understand that NFA, AAUP and the AFT may use automated calling techniques and/or text message me on my cellular phone on a periodic basis. NFA, AAUP and AFT will never charge for text message alerts. Carrier message and data rules may apply to such calls or messages.
Work Phone Number
Optional
Personal Email*

Confirmation EmailFor NFA website login and emails, shared only with AAUP and AFT.
Work Email

Confirmation Email
Residential Address*

Street Address

Street Address Line 2

CityState

Zip Code
Mailing address is the same as street address
Mailing Address

Mailing Address

Mailing Address 2

CityState

Zip Code
Dues are calculated as 0.5% of your annual base salary and divide by 12 for monthly payroll deductions.
Annual Base Salary
To see an estimate of your monthly dues, please enter your current annual base salary.
Monthly Payroll Deduction (est.)
This is provided for guidance only. NSHE Payroll will calculate the monthly deduction from your actual salary.

Enrollment

Yes - I want to join my fellow employees and become a member of the {institution139} chapter of the Nevada Faculty Alliance, the American Association of University Professors, and the American Federation of Teachers.
DRI Collective Bargaining Authorization*

I hereby authorize the Nevada Faculty Alliance to represent me for the purpose of collective bargaining with Desert Research Institute.
GBC Collective Bargaining Authorization*

I hereby authorize the Nevada Faculty Alliance to represent me for the purpose of collective bargaining with Great Basin College.
UNLV Collective Bargaining Authorization*

I hereby authorize the Nevada Faculty Alliance to represent me for the purpose of collective bargaining with University of Nevada, Las Vegas.
UNR Collective Bargaining Authorization*

I hereby authorize the Nevada Faculty Alliance to represent me for the purpose of collective bargaining with University of Nevada, Reno.
Collective Bargaining Authorization

Monthly Payroll Deduction:

Dues:	(0.5% of Annual Base Salary)/12
NFA-PAC Contribution:	{nfapacContribution}
Additional Contribution:	{additionalContribution124}

Signature*

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Date*

MonthDayYear

Payroll Deduction Authorization
I hereby authorize the Nevada System of Higher Education to deduct from my salary and to pay the Nevada Faculty Alliance the agreed monthly payroll deduction as NFA professional dues for the current membership year and each year thereafter. I fully understand that the annual dues, fees, and assessments required in the three associations are subject to periodic change by the governing bodies of the association and authorize NSHE to deduct any modified monthly dues, fees, and assessments established by the governing bodies of the three associations, unless my obligation to do so ends under one of the circumstances set forth here. This authorization supersedes any previous payroll deduction for NFA. This authorization continues from year to year, regardless of my membership status, unless altered by a new payroll deduction or I (a) revoke this authorization in a signed writing sent to my campus payroll office and by sending e-mail notice to the NFA at admin@nevadafacultyalliance.org between July 1-15, of the membership year immediately preceding the membership for which the authorization is to be revoked, or (b) my employment with NSHE ends.
Employee Name

{name}
NSHE Employee ID Number*
May be found on employee pay slip in Workday
Please use the 9-digit employee number from your profile in Workday. You may also find your Employee ID number on your pay slip,

Click here to see an example!

X

NSHE employee pay slip information
Employee Signature*

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Date*

MonthDayYear
NFA Email*
example@example.com
State Board Email
Please verify that you are human*
Should be Empty:

NFA Membership Application

Optional Monthly Additions

Enrollment

Monthly Payroll Deduction:

Payroll Deduction Authorization

Employee Name