<p> (For Office Use Only) RETIRED MEMBERSHIP APPLICATION LOCAL ID # 2000 PLEASE RETURN THIS APPLICATION WITH PAYMENT TO: Oregon Education Association (or OEA) Membership Department – Attn: Becky Nelson 6900 SW Atlanta St Portland, OR 97223-2513 503-684-3300</p><p>YOU CAN ALSO PAY ONLINE WITH A VISA OR MASTERCARD AT: http://www.nea.org Then click on JOIN NEA, then “Retired” and follow instructions. 2012-2013</p><p>Complete for New Retiree Information Oregon-Retired EA</p><p>Name Please check one box below for NEA-R and one box for OEA-R (Please Print Clearly) NOTE: Membership at both levels is required Address NEA Options: Dues Amounts  Retired Life (Pre-paid in Full) $ 0.00 City State Zip  Retired Life $250.00  Retired Annual * $ 30.00</p><p>Last District where you were employed OEA Options Dues Amounts  Retired Life (Pre-paid in Full) $ 0.00  Retired Life $250.00 SSN: _____ or Member ID#: ______ Retired Life – 2-Yr Plan: st SSN’s are for Membership Verification purposes only. OEA is sensitive to privacy concerns of members and follows 1 of 2 payments * $125.00 appropriate security procedures to safeguard this important information.  Retired Annual * $ 25.00 Personal E-Mail Address: ______TOTAL DUES: $ ______Email is the OEA-Retired EA’s preferred method of communication</p><p>Phone:______</p><p>Date of Birth: ______/ ______/______Gender: Female Male *Billing statements for the following membership year are sent out in mid-August. mm dd yyyy</p><p>SIGNATURE:______DATE:______</p><p> For NEA FCPE and/or OEA PIE CONTRIBUTIONS, please use reverse side. </p><p>D:\Docs\2018-04-17\0bc3b5c95ff4d392201dc318bca0ce09.doc MAKE YOUR VOICE HEARD! OEA-PIE AND THE NEA FUND</p><p>PAC DISCLAIMER The National Education Association Fund for Children and Public Education collects voluntary contributions from Association members and uses these contributions for political purposes, including, but not limited to, making contributions to and expenditures on behalf of friends of public education who are candidates for federal office. Only U.S. citizens or lawful permanent residents may contribute to the NEA Fund. Contributions to The NEA Fund for Children and Public Education are voluntary; making a contribution is neither a condition of employment nor membership in the Association, and members have the right to refuse to contribute without `suggested amount, or may contribute nothing at all, without it affecting his or her membership status, rights, or benefits in NEA or any of its affiliates.</p><p>Contributions or gifts to The NEA Fund for Children and Public Education are not deductible as charitable contributions for federal income tax purposes.</p><p>Federal law requires political committees to report the name, mailing address, occupation, and name of employer for each individual whose contributions aggregate in excess of $200 in a calendar year.</p><p>Federal law prohibits The NEA Fund for Children and Public Education from receiving donations from persons other than members of NEA and its affiliates, and their immediate families. All donations from persons other than members of NEA and its affiliates, and their immediate families, will be returned forthwith.</p><p>Voluntary Contribution for OEA PIE (sign below) OEA PIE $______Voluntary Contribution for NEA FCPE (sign below) NEA FCPE $______</p><p>TOTAL DUES AND PAC CONTRIBUTION $______</p><p>PAC AUTHORIZATION </p><p>SIGNATURE:______DATE:______</p><p>NOTE: PAC Contributions cannot be made online through the NEA website. There is a link there, however, to the OEA website where you CAN use a credit card for PAC contributions. Or, you can pay your dues online, then use the enclosed envelope to send in your PAC contributions. If you are paying your dues by check, PAC contribution amounts can be included in the total as long as you note the amount meant for PAC in the above section. Make checks payable to OEA. </p><p>D:\Docs\2018-04-17\0bc3b5c95ff4d392201dc318bca0ce09.doc</p>