Online Membership Registration Membership Registration Membership Type * MEP Administrator Aspiring Administrator Retired Administrator Total Yearly Fee Work Location Location Number * Location Name * Region NorthSouthCentralAdult/Post-SecondaryRetired Member Information First Name * Last Name * Employee Number * Position * Email * Birthdate * Work Phone Mobile Phone Did someone recruit you? Yes No Recruited By Information Please fill out as much information you can about the person who recruited you. Recruited By First Name Recruited By Last Name Recruited By Title Recruited By Work Location Recruited By Email Address Do you want to join the Sick Leave Bank Yes No Administrators’ Sick Leave Bank Enrollment I hereby authorize the School Board of Miami Dade County, Florida to deduct the amount of day(s) as listed below from my personal/sick leave as my initial enrollment in the Administrators’ Sick Leave Bank Program. I further authorize an additional day of deduction should the Sick Leave Bank reach a point of depletion. I understand that there is a ninety (90) day waiting period before any claims to the Sick Leave Bank will be honored. I understand that such membership is revocable upon ninety (90) days written notice to the Dade Association of School Administrators. The minimum deposit, however, shall remain in the Sick Leave Bank. Only full time administrators who have been employed by Miami Dade County Public Schools for at least one year as an administrator and who have at least five (5) days or more of sick leave, are eligible for initial enrollment. Number of sick/personal day(s) to be deducted: Payment Method Payment Method * MEP Payment Method MEP Payment Method * Payroll Deduction Authorization Administrator Payroll Deduction ($17.50 Per Pay Period) I hereby authorize the School Board of Dade County, Florida, to deduct dues from my salary as indicated above and in the future in amounts certified annually by the Dade Association of School Administrators. I authorize the distribution of the monies deducted to the designated organizations and release the School Board and its employees from any liability after the deduction has been distributed. This authorization will remain in effect unless revoked by me. I also pledge to keep my membership active and in good standing for at least one year. Make checks payable to DASA *A portion of the annual dues will be used to support the DASA PAC. Member Signature * signature keyboard Clear Submit If you are human, leave this field blank.
