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 Home Address * Home Address Home Address Home Address City City State State Zip/Postal Zip/Postal 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 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 * logo acf-forms activecampaign authorize aweber bootstrap campaignmonitor constant_contact getresponse googlesheets highrise hubspot mailchimp mailpoet paypal icon polylang salesforce salesforcealt stripe stripealt twilio woocommerce Zapier required delete move drag clear noclear duplicate copy clone tooltip tooltip_solid forbid checkmark image checkmark circle checkmark square check check1 plus plus1 plus2 plus3 plus4 minus minus1 minus2 minus3 minus4 cancel cancel1 close report_problem_solid report_problem arrowup arrowup1 arrowup2 arrowup3 arrowup4 arrowup5 arrowup5_solid arrowup7 arrowup6 arrowup8 arrowdown arrowdown1 arrowdown2 arrowdown3 arrowdown4 arrowdown5 arrowdown5_solid arrowdown7 arrowdown6 arrow_left arrow_right filter download upload2 download2 hard_drive pencil_solid pencil signature register account_circle_solid account_circle address_card paragraph checkbox_unchecked checkbox checkbox_solid dropdown caret_square_down radio_unchecked scrubber location_solid location toggle_on toggle_off shield_check shield_check_solid clock clock_solid email_solid mail_bulk code tag tag_solid price_tags search sitemap file file_text_solid file_text option option_solid more_horiz more_vert more_horiz_solid more_vert_solid calculator key key Filled Key Icon keyboard eye eye_solid eye_slash_solid page_break view_day attach_file printer header h1 repeat repeater save sliders code_commit star star_full star_half linear_scale pie_chart stats_bars sms feed align_right align_left button browser cloud_upload_solid shuffle swap pallet fingerprint ghost heart_solid heart history import export label_solid label lock_open lock alt_lock dollar_sign percent notification external_link pageview_solid pageview settings stamp support text white_label building icontact sendinblue sendy wordpress credit_card credit_card_alt cc_amex cc_discover cc_mastercard cc_visa cc_paypal icon cc_stripe price product total quantity directory Preview 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. Δ
