INSTRUCTIONS FOR COMPLETING IEA BLANK MEMBERSHIP …



[pic]2018-19 SIUC FA INSTRUCTIONS FOR COMPLETING

PAYROLL DEDUCTION AUTHORIZATION FOR UNION DUES

1. Enter your AIS (employee) ID number.

2. Fill in your name.

3. Enter your address. (For those of you with a post office box number address it is very important that you also list your legal street address.)

4. Enter the department you work in.

5. Enter the month/year of the pay period you wish your membership to begin. (Examples: Aug. 2018 (Sept. paycheck); Sept. 2018 (Oct. paycheck): etc.

6. Sign and date your authorization form.

(Detach and return bottom portion, to J’Neita Fassel, IEA-NEA, 500 E. Plaza Drive, Suite 5, Carterville, IL 62918. For questions call 1-800-431-3730. IEA-NEA Enrollment forms will be mailed upon receipt of the Dues Deduction Form. The IEA-NEA Form will finalize your membership in the SIUC Faculty Association, IEA-NEA and result in the issuance of your IEA-NEA Membership Card. This card gains you access to the MEMBERS ONLY portion of the IEA-NEA website at (including member only discounts).

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PAYROLL DEDUCTION AUTHORIZATION UNION DUES

Southern Illinois University at Carbondale

TO: Payroll I am paid: ( Biweekly ( Semi-monthly ( Monthly

I continue to authorize my employer (including any other employer to which my employment is transferred by law or agreement) to deduct from my pay Association dues in the amount of $69.40 and voluntary contributions to IPACE, as these sums are annually established, and to NEA FCPE, as previously agreed to, and to forward such amounts to my local association SIUC FA IEA/NEA (or IEA-NEA, if the local association is no longer affiliated with IEA-NEA). This authorization is to continue in force, regardless of my membership status, unless a) revoked by me for a succeeding membership year by giving written notice to that effect to both my employer and local association on or before September 15 or b) my employment ends.

LAST 4 Digits Soc. Sec. No. __________

Employee ID No. (see check stub; if necessary call SIUC HR: 618/453-6600)

Name: __________________________________________________________________________

LAST FIRST MIDDLE

Street ___________________________ City _______________________ State/Zip ______________

SIUC Department: _______________________________________________

Effective Pay Period: _______________

______________________________________________________________________________________

EMPLOYEE SIGNATURE DATE

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