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NEA APIC Membership Form 2021-2022
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Preferred Phone Number
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Your answer
State Affiliate (please type out the name - do not use acronyms)
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Your answer
Local Affiliate (please type out the name - do not use acronyms)
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Your answer
NEA Membership Number (if you know it - it can be found on your NEA Today)
Your answer
Type of APIC Membership
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Active (Active, Student, or Retired NEA Member or Spouse/Partner is of Asian and/or Pacific Islander Ethnicity) - $20
Associate (if you do not qualify for Active Membership as defined above) - $15
10-year Active (same criteria as above) - $160
Ethnic Background of Member (check all that apply - please note this is not an exhaustive list of ethnicities per region):
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Native Hawaiian / Kanaka Maoli
Pacific Islander (Chamorro, Fijian, Maori, Marshallese, Palauan, Samoan, Tahitian, Tongan, etc.)
South East Asian (Burmese, Cambodian, Filipino, Hmong, Indonesian, Karen, Karenni, Laotian, Thai, Vietnamese, etc.)
East Asian (Chinese, Japanese, Korean, Macanese, Mongolian, Taiwanese, Tibetan, etc.)
South Asian (Afghan, Bangladeshi, Bhutanese, Indian, Maldivian, Nepalese, Pakistani, Pashtun, Sri Lankan, etc.)
West Asian (Armenian, Azerbaijani, Iranian, Iraqi, Jordanian, Kuwaiti, Lebanese, Omani, Qatari, Turkish, Saudi, Syrian, Yemeni, etc.)
Non-API Ethnicity
Prefer Not To Answer
Required
Specific Ethnicity(ies) of Member:
Your answer
I am paying my membership dues by:
*
Online payment (processing fee applies) - links for payment options are on the website
Check payable to "NEA Asian Pacific Islander Caucus" - address for mailing the check is on the website
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