UEA Enrollment Card

UNIVERSITY EDUCATION ASSOCIATION MEMBERSHIP ENROLLMENT CARD

Last 4 SSN*

Name (First)*

Middle Initial

Name (Last)*

Home Address*

City State ZIP*

Local #7266 Campus (choose one)

CollegeDept

Home Phone*

Please enter a valid phone number.

Campus Phone

PLEASE INITIAL EACH BOX AND SIGN YOUR NAME AND DATE BELOW.

Yes, I want to join with my fellow employees and become a member of the University Education Association (hereafter, "my local"), Education Minnesota, the National Education Association, and the American Federation of Teachers. I hereby request and voluntarily accept membership in these associations and agree to abide by the Constitution and Bylaws of all four associations. Payment method and summary - payroll deduction.*

Membership dues fees and assessments and any voluntary contributions for the academic year ending August 31 2026 total tenuretenuretrack members and 99883 for termfaculty members and will be deducted from your paychecks throughout the*

I authorize my employer to deduct and remit to my local from my pay in each pay period a pro-rata portion of the annual dues, fees and assessments required for membership in my local, Education Minnesota, the National Education Association, and the American Federation of Teachers, the current rates for which are as follows: National dues: $261.36 -- State Dues: $551.00 -- Local dues: 202.70 for tenured and tenure-track and $182.43 for term faculty*

I fully understand that the annual dues required for membership in the four associations are subject to periodic change by the governing bodies of the associations and authorize my local to deduct any modified monthly dues, fees, and assessments established by those governing bodies unless my obligation to do so ends under one of the circumstances set forth below. This authorization continues from year to year, regardless of my membership in the union, unless: (a) I revoke it by submitting written notice to the local union during the thirty-day period that begins on Sept. 1 and ends on Sept. 30, in which case my revocation will take effect on Oct. 1 in the year in which I submit the notice; or (b) my employment with my current employer ends. If any provision of this agreement is determined to be unlawful or invalid, the remaining provisions will remain in effect.

Political Action Committee (PAC): Your dues include $30 per year for the Education Minnesota PAC. The PAC uses these contributions to fund political action efforts to strengthen the collective voice of educators in public policy making. A request for a refund of the Education Minnesota Political Action Committee contribution will not affect membership rights or benefits. Only United States citizens should contribute to the

Education Minnesota Political Action Committee.

Foundation for Excellent in Teaching & Learning: Your dues include $5 per year toward the Education Minnesota Foundation. The foundation uses some of these contributions to fund member grants as well as workshops that support and promote access to learning and excellence in teaching.

Members desiring a refund from either the PAC or the foundation must mail, email, or hand-deliver a signed, original refund request form specifying the member's refund request within 30 days of submitting this membership form. Refund requests must be resubmitted annually no later than Oct. 31. Members can request the form by calling 800-652-9073.

Dues, including contributions to the PAC and Education Minnesota Foundation, are not tax-deductible as charitable contributions. The annual dues rate will apply unless you join midyear, in which case your dues will be prorated for that membership year.

Voluntary and legally binding agreement

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

I UNDERSTAND THAT INITIALING A BOX CONSTITUTES A LEGAL SIGNATURE CONFIRMING MY UNDERSTANDING AND AGREEMENT*

Applicant Signature

Date*

Date

UEAD