Online LEA Membership Form

19465 Deerfield Avenue, Suite 206
Lansdowne, VA 20176
Phone: (703) 858-7700
Fax: (703) 858-7712
Email: LEAOffice@LoudounEA.org
Website: www.LoudounEA.org
Facebook: www.fb.com/LoudounEA
Online Membership Form - MEMBERSHIP MATTERS
Are you an LCPS Employee? *

Yes! No, I do not work for the school system.

LEA membership is only available for employees of the Loudoun County Public School system. But don't worry! There are still quite a few ways you can get involved in our work to #PutKidsFirst and advocate for the schools our community deserves.

Fill out the survey below and we'll contact you about opportunities to get involved. Thank you!
First Name *
Last Name *
Best Contact E-mail *
Best Contact Number *

- Area Code Phone Number
Phone Type *

Home Mobile Work
Community Role *

Parent Business Community Member Faith Community Member Community Organization Member PTA/PTO/PTSA Member

Great! Please fill out the form below to join:
First Name *
Middle Initial *
Last Name *
Cell Phone *
Home Phone
Work Email *
Personal Email *
Work Location *
Position *
Work Location
School Name, Transportation, Admin..
Receive Text Messages

Yes! No, thank you
Date of Birth (please tab to enter Month/Day/Year fields) *

- Month - Day Year

Home Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

PID Number *
Last 4 digits of your Social Security Number *
I was a student VEA member last year.
Ethnic Minority Information (Optional)

African American American Indian/Alaska Native Asian Caucasian Hispanic Multi-Ethnic Native Hawaiian/Pacific Islander Unknown/Unidentified
Membership and Dues (based on a biweekly payroll schedule) *

Full-time certified -- $25.50 per payroll Part-time certified -- $13.19 per payroll Full-time classified (ESP) -- $13.54 per payroll Part-time classified (ESP) -- $7.32 per payroll Substitute -- Please contact the LEA Office at (703) 858-7700 for more information.
I am a First Year Teacher this year.
Dues Payment *

Cash pay authorization: I prefer to pay my dues with a one-time annual payment. A check payable to Loudoun Education Association is attached for the full amount of my annual dues. I understand that my membership will not automatically renew and I will be invoiced each year.
Dues Payment *

Payroll deduction authorization: I hereby authorize the Loudoun County School Board to deduct Loudoun Education Association dues in equal installments from my paycheck. This authorization shall remain in effect from year to year, for dues amounts determined by the Association, until revoked in writing to the Loudoun County School Board and the Association by the 15th of the month for which it is my obligation to settle any unpaid balances directly with the Association. Furthermore, I authorize Loudoun County Public Schools to notify the Association of any change in my work location, address or name.
LEA/VEA/NEA representation will be available only if you are a member at the time of the incident.

By providing my phone number, I understand that the National Education Association and its affiliates, including the Virginia Education Association, the local Association, NEA Member Benefits, and NEA360, may use automated calling techniques and/or text message me on my cellular phone on a periodic basis. The National Education Association, the Virginia Education Association, and the local Association will never charge for text message alerts. Carrier message and data rates may apply to such alerts. Text STOP to 787753 to stop receiving messages. Text HELP to 787753 for more information.
Who should we thank for referring you to LEA?
Electronic Signature *
Today's Date *

- Month - Day Year
Date

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Online Membership Form - MEMBERSHIP MATTERS

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