DASA Membership Application

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Option 1

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Title *

Mrs.

Ms.

Mr.

Dr.

Other:

First Name *

Last Name *

Education Agency *

School Name/Agency Department *

Position

Assistant or Associate Principal

Assistant Superintendent

Buildings and Grounds Admin

Chief Financial Officer

Chief School Officer/Superintendent

Curriculum and Instruction Admin

Principal

School Leader/Head of School

School Nutrition Services Admin

School Personnel/Human Resources Admin

Special Education/Programs Admin

Student Support Services Admin

Transportation Admin

Other:

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Business Address (include number & street, city, state, zip code) *

Office Phone *

Cell Phone

Email Address (District or Charter email preferred) *

Home Address (include number & street, city, state, zip code) *

DASA Membership ($355) is Required for Department Membership. Select the department you wish to join. *

Delaware Association of School Business Officials ($5)

Delaware Association of School Personnel Administrators ($15)

Delaware Association of School Principals ($100)

Delaware Association of Curriculum and Instruction Supervisors ($10)

Delaware Chief School Officers Association ($50)

Delaware Association of Special Education Professionals ($25)

Delaware Child Nutrition Services Supervisors Association ($5)

Delaware Association of Assistant Superintendents ($10)

AASA ($470)

NAESP ($259) if an Assistant Principal ($219)

NASSP ($250)

None of the above

Other:

Required

Enter Total Membership Dues Below ($355 plus department membership) *

With full knowledge of the above, I authorize my employer to deduct from my salary and pay to the association, in accordance with the agreed upon payroll deduction procedure, my association dues as may be determined from time to time as indicated above for the current membership year and each membership year thereafter, provided that I may revoke this authorization as of July 1 of any calendar year by giving written notice to that effect to DASA and my employer on or before June 30 of that year. Payment of Dues: *

I authorize the above fees to be paid to DASA via payroll deduction (as indicated above).

I will be sending in a check payable to "DASA" to pay my dues.

My District will pay $ ________________ of my dues and I will pay $ _______________ of my dues. My share of dues will be paid by payroll deduction _______ check ______.

Required

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