Community Ally

NEA-New Mexico Community Ally Membership Application
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile/Home Phone*

Country CodeArea CodePhone Number
Personal E-mail*
example@example.com
Date of Birth (optional)

MonthDayYear
Date
Registered to Vote? (optional)

YesNo
Ethnicity

American Indian/Alaska NativeNative Hawaiian/Pacific IslanderHispanicAsainBlackWhiteMultiple RacesOther
Gender (optional)

FemaleMaleTransgender FemaleTransgender MaleGender Expansive/Non-ConformingOther
Political Party (optional)

IndependentDemocratRepublicanOther
Total Dues*
prevnext( X )
Community Ally Membership
$50.00



EdPACOptional donation
$10.00 Quantity



Foundation for the Improvement of EducationOptional donation
$10.00 Quantity



Total

$0.00
Fifty dollars ($50.00) are the combined national and state dues for becoming a Community Ally. Out of the state portion of twenty-five ($25.00), two dollars ($2.00) of the amount collected from Community Ally is a voluntary contribution to the NEA-New Mexico Foundation for the Improvement of Education. Three dollars ($3.00) of the amount collected from a Community Ally is a voluntary contribution to the NEA-New Mexico Education Political Action Committee (EdPAC).

Only U.S citizens or permanent resident may contribute to NEA-NM EdPAC. If you are not eligible to contribute, please contact NEA-NM before completing this form and remitting your payment.

Both the NEA-NM Foundation and EdPAC are not deductible as charitable contributions for federal income tax purposes.

Membership does not become effective until payment is received.
Signature*

Clear
Your e-signature is a verification that you have read and agreed to NEA-NM terms mentioned above.
Today's Date

MonthDayYear
Date
If you come across any issues or if you have questions, please call us at 505-982-1916 or by email at info@neanm.org.

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NEA-New Mexico Community Ally Membership Application