23-24 Other Membership

Substitute and Reserve Membership Application 2023-2024
Full Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Phone*
Personal E-mail*
example@example.com
Local Association*
School Worksite*
Job Category*
Work Phone
Date of Birth*

MonthDayYear
Date
Ethnicity

American Indian/Alaska NativeNative Hawaiian/Pacific IslanderHispanicAsainBlackWhiteMultiple RacesOther
Gender

FemaleMaleTransgender FemaleTransgender MaleGender Expansive/Non-ConformingOther
Total Dues*
prevnext( X )
Reserve CertifiedNEA Dues- $90.50 NEA-NM Dues- $25.00
$115.50



Reserve ESP/ClassifiedNEA Dues- $50 NEA-NM Dues- $25
$75.00



SubstituteNEA Dues- $15 NEA-NM Dues- $15
$30.00



NEA-NM EdPACOptional Contribution
$20.00 Quantity



Total

$0.00
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
I hereby agree to pay cash or by credit card for my full dues. Membership does not become effective until payment is received.

If you are paying by cash please print form once signed, and mail to:

NEA-NM Membership Processing

2007 Botulph Road

Santa Fe, NM 87505

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

Payment Methods

Debit or Credit Card

Please click one of the PayPal options to complete payment and submit the form.

Substitute and Reserve Membership Application 2023-2024