Membership Card

Jefferson County American Federation of Teachers Dues Deduction Authorization

I hereby authorize the Board of Education to deduct membership dues from my paycheck to be remitted to the Jefferson County American Federation of Teachers.  I understand that if I wish to cancel my membership that I must do so, in writing to the organization and to the appropriate personnel in the District Finance Office on or before September 15th of the current membership year, or membership will continue.

 

IRS TAX DISCLOSURE REQUIREMENT: Dues paid to the Jefferson County American Federation of Teachers may not be deductible for federal income purposes; however, under limited circumstances dues may quality as a business expense.

 

CHECK ONLY ONE:

Jefferson County School District

Leeds City Schools

Trussville City Schools

Vestavia Hills City Schools

Member-At-Large (Other than districts listed above)

 

CHECK ONE:

Certified

Classified

Ketona

 

Fill Out the Following Form, Print Page, Sign, and Send To:

Jefferson County AFT Local 2143

1900 20th Street South  *  Birmingham, AL  35209

205-933-1124 Phone  *  205-933-1101 Fax       .

 

Mr/Mrs/Ms:

Social Security Number:

Address:

City: State: Zip:

Worksite: Position: Subject:

Home Phone: Cell Phone:

E-mail Address:

Recruiter:

 

Signature:  _____________________________________________

                                 

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Accounting Department

CHECK ONLY ONE:

                                   Jefferson County School District

                                   Leeds City Schools

Trussville City Schools

Vestavia Hills City Schools

I hereby request that you discontinue dues deductions for the

JCEA/LCEA/VHEA/TCEA Organization, effective immediately.

 

Name:  ________________________________ Signature: ________________________________ Date: ____________

Hold until September