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Prefix*

Ms.
Mrs.
Mr.
Dr.

Name*

First Last

Gender*

F
M

Bargain Unit Member

Yes / True
No / False

Date of Birth*

Title/Position*

Position Start Date*

Email*

Home Phone*

Work Phone*

Fax Number

Mail Preference*

School
Home

District in Which You Reside*

Home Address*

Street Address Address Line 2 City State ZIP Code

School Name*

School Address*

Street Address Address Line 2 City State ZIP Code

Membership Type

PLEASE NOTE: Membership dues are not deductible as charitable contributions for income tax purposes. Dues may be considered ordinary and necessary business deductions.

DUES AND MEMBERSHIP TYPES:

Questions on dues calculations or options? Please email kduffy@saanys.org

REGULAR category: (Salary defined as regular salary reported to Teachers Retirement System) NOTE: Minimum Amount=$250 Maximum Amount=$600

Annual Salary*

(example: $35000 X .006 = Dues Total)

Regular Membership Dues

Price: $0.00

Retired Active

Price: $250.00

Retired Affiliate

Price: $125.00

Retired Associate

Price: $40.00

Professional

Price: $40.00

Graduate

Price: $40.00

Library

Price: $50.00

Membership Options

No Additional Options
NASSP ($250.00)
NAESP ($259.00)

Member must ensure that any unwanted options are not checked or is responsible for charges:

Membership Options*

No Additional Options
NASSP ($50.00)
NAESP Emeritus ($99.00)

Member must ensure that any unwanted options are not checked or is responsible for charges:

SAANYSPAC

$35 Suggested minimum voluntary contribution. Indicate preferred amount by typing into the field, if desired

$10,000 life insurance benefit (included)

Price: $0.00

(Regular and Retired Active/Affiliate members only)

Contact kduffy@saanys.org for optional life insurance add-ons.

Total

$0.00

Pay By

Credit Card
Check / P.O.

Billing Address*

Street Address Address Line 2 City State ZIP Code

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

To pay by check or purchase order, you will need to fill out this form, print out the Registration Summary Page when it appears, and mail it with your check or purchase order to SAANYS (address appears on the summary page).

Membership year runs from September 1-August 31.