West Texas Alliance - New Member Sign Up Form
Complete the information below. If you have any questions please contact a WTA representative.
Personal Information
Full Name
*
Mr.
Mrs.
Ms.
Dr.
Prefix
First Name
Middle Name
Last Name
Suffix
Email Address
*
Confirmation Email
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
City
State
Zip Code
Date of Birth
*
-
Month
-
Day
Year
Type or Select
Employment Information
District
*
Clint ISD
Socorro ISD
Ysleta ISD
Employee ID#
Campus/Department
*
Work Phone Number
*
Please enter a valid phone number.
Job Title / Assignment
*
District Email Address
*
Confirmation Email
example@example.com
Do you need to cancel another association? If no select None, if yes choose the association below. Note: WTA will cancel your other membership.
*
Please Select
ATPE
SEA
SAFT
YTA
TSTA
TCTA
NONE
By initialing below I understand that I am authorizing the school district to cancel my payroll deduction(s) for the benefit listed above and that any other payroll deductions will remain the same. If you selected none above, put NA.
Initial Here
Membership Dues & Responsibilities
I hereby authorize deductions from my Socorro ISD, Clint ISD, Ysleta ISD, or Other district listed payroll for dues to the West Texas Alliance. I understand these deductions will continue annually, including any increase in dues that may occur, for the duration of my employment unless I submit written notification to Socorro ISD, Clint ISD, Ysleta ISD, or Other district listed payroll department and West Texas Alliance, revoking this authorization. I understand that it is My responsibility to monitor the accuracy of my deductions within 60 days of the occurrence and no dues will be refunded after that. It is also my responsibility to inform West Texas Alliance, in writing, of my retirement resignation from SISD, Clint ISD, Ysleta ISD or Other district listed within 60 days. I understand dues will not be refunded after 30 days.
Dues (Payroll Deduction)
Certified: $44/month, Support: $27/month, Bus Drivers: $16.20/pay period/20 pay cycles; Auxiliary: $17/month
Responsibility of Dues
*
I understand it is my responsibility to monitor my dues and notify WTA of my employment separation from SISD/CISD/YISD/Other district listed.
Paycheck Deduction
*
I understand my dues will be automatically deducted from my paycheck.
Electronic Signature Consent
By signing below I fully understand all the terms of joining West Texas Alliance (WTA) and I consent to provide an electronic signature on this form. I further acknowledge that all of the information I have provided on this form is my own, and is true and correct.
Signature
*
Submit My Application
Should be Empty: