2019-2020 MEMBERSHIP APPLICATION FORM (MONTHLY DEDUCTION ONLY)


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All fields marked with an * are required.

First name is required.
Last name is required.
Personal email is required.Invalid Email.

2019-2020 MEMBERSHIP APPLICATION FORM


Please complete this form carefully, then press "SUBMIT" to send your application for processing.
The information requested below will remain confidential and will be used for ACSA purposes only. Information will not be sold to vendors or any third parties. - Thank you, ACSA Member Services


All fields marked with an * are required.

Payment Option



Authorizing party is required.
Phone number is required.
Email is required.Invalid Email.

Membership Type



Have you been an ACSA member within the last 12 months?

District is required.

Are you represented by an exclusive bargaining representative?

What is your job classification?*

Job Classification is required.

Please Select an Owner Group Type

Please Select an Owner Group Type

Please select one of the following options:

Please Select a Job Category

Please select one of the following options:

Retired Date

Invalid retired date.

I authorize ACSA full Retired dues to be deducted monthly from my CALSTRS pension. This authorization shall be in effect until revoked by written notice from me or from ACSA. I consent to the adjustment of this deduction to reflect any change in annual dues approved by the ACSA Board of which STRS may be advised by ACSA.

Please upload the proof of enrollment and credential due date


Proof of enrollment may include but not limited to a copy of your current enrollment form or a letter from your professor verifying enrollment.

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{{file.name}} | File size greater than 5 MB Invalid file formatProof of enrollment is required.

Credential Due Date

Invalid credential due date.

LIMITATIONS: A change of employment designation to administrative or supervisory will require a change to Regular membership.

Student members do not have voting privileges, and are not eligible to serve as ACSA officers, directors, or committee members, nor are they eligible for Professional Legal Services.Qualifying members may remain in the Student category a maximum of four years. Beyond that, a change in membership type and dues will result.

Current Annual Salary
(Required for Payroll Deduction)
*

Only enter a numeric valueCurrent Annual Salary is required.

Please Select a Job Category


Profile Information


First name is required.
Last name is required.
This information is used to correctly identify members for payroll deduction purposes and/or avoid duplication.
Invalid birth year.Invalid birth year.
If retired, please enter your job title prior to retirementPosition/Title is required.
District is required.

Contact Information



Home Address


Address Line1 is required.
City is required.
State is required.
Zip code is required.
Home address is used for contact in case you leave the district or retire.
Mailing preference is required.

Work Address



Address Line1 is required.
City is required.
State is required.
Zip code is required.

Email


Personal Email is required.Invalid Email.
Invalid Email.
ACSA publications preference is required.
I understand that I will continue to receive communications for membership billing and profile updates

Phone



Length should be 10 digits.
Length should be 10 digits.Mobile phone number is required.
Work Phone Number Length should be 10 digits.

Social Media



Invalid Twitter Handle.

Would you like to volunteer and help shape the organization:*

Please select an option.

Did an ACSA member referred you to join? If so, tell us who and we'll reward them with a $25 ACSA Gift Certificate!

ACSA Affiliate Membership Opportunity



Check below to become a member in one or more of ACSA's official affiliates:

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Click to Choose Superintendent or Other Admin

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Total

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*Contributions to support ACSA’s political activities are not tax deductible. ACSA retains sole discretion over use of member political contributions. Dues may be deductible as business expenses. ACSA estimates that the non-deductible portion of dues allocable to lobbying is 13.3%.

Annual Dues


Dues are prorated for the number of months remaining in the school year for members joining after July (For new members only).

Signature (Required)*


Signature is required.

Please fill the captcha


Invalid Captcha.

Before you submit your application, please share with us your overall satisfaction with this application form. If you have specific suggestions about the form, we'd be happy to read them below, or you can send them to us at memberservices(at)acsa.org.

It's quick and simple - 5 Stars if you think we did a GREAT job designing a form to help you provide all your important information - 1 Star if you think we could have done better - THANKS!!!
Specific comments about the rating above if you'd care to share them:

Questions?

Call ACSA Member Services at 800.608.2272 or email memberservices(at)acsa.org

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