Payroll Deduction (PRD) Enrollment Form

Payroll Deduction (PRD) Enrollment Form

Use this form to enroll or update your membership dues payment method to payroll deduction. Submit by September 6 at 5:00 PM for timely processing. *If you previously selected Payroll Deduction, you do not need to complete this form unless you have changed districts or membership level. Unsure? Call us at 919-788-9299 (1-800-542-8844).
If you are NEW to PENC, you need to create an account before completing the payroll deduction form.

Click this link to register as a new member: REGISTER
Name

First NameLast Name
School Email/Personal Email
example@example.com
Enter Name of School District*
Mobile Phone Number*
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Last 5 digits of Your Social Security Number
Please indicate if you are new member selecting payroll deduction or an existing member renewing or switching to payroll deduction

New member selecting payroll deductionExisting member renewing membership and payment through payroll deductionExisting member renewing and switching payment method to payroll deduction
Please indicate your Membership level for Payroll deduction:

Non-first Year Teachers, Certified Staff and Administrators $28.13/ 8 pay periods ($225 a year)First Year Teachers and Classified Support Staff - $13.75/ 8 pay period ($110 a year).
By signing below, I authorize my school district to deduct PENC dues from my salary at my selected membership level and corresponding rate. This payroll deduction authorization will remain in effect each year unless terminated in writing to both my school district and PENC. If my employment ends (except in the event of death), any remaining balance may be deducted from my final paycheck. PENC will notify members and districts annually of any dues adjustments.
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