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New Member Application

First Name

Last Name

Middle Initial

Personal Email

Phone

Street Address

City

Postal/Zip

Recruiter Name (if applicable)

Have you ever been disciplined as a SRCSD employee or at a previous job?

Yes

Have you ever had job performance issues or been placed on any sort of performance plan?

Yes

School or worksite name

Birthday

I understand that false or misleading information given in my application may result in termination of my SRPE membership. I further understand that there will be a 2 (two) month probationary period that I may have fewer rights than I will enjoy after this period. During this period SRPE’s ability to represent me by be limited. My signature at the end of this application indicates that I understand that SRPE does not provide any representation for any condition that existed before, or at the time of my signing this application.

Payment

Register with Bank

Choose this option below to pay your monthly dues using your bank account. You'll be redirected to a secure page where you can enter your banking information (ACH) to set up the payment. If you need to resume later, a link to your Stripe Checkout Session will be sent to your email, valid until the expiration date. Secure and convenient, it's a great way to manage your membership!

Register with Card

Choose this option below to be taken to a secure page where you can enter your card details to process your monthly dues. If you wish to continue the process later, a link to your Stripe Checkout Session will be emailed to you, allowing you to resume within the link's expiration date. Fast and flexible, it's perfect for keeping your membership up to date!

Monthly Dues Based on Salary

Salary	ACH Payment	Credit/Debit Card
$47,500 and above	$46.15	$47.79
Under $30,000	$24.00	$25.00
$30,000 - $47,499	$28.00	$29.12

By checking this box and completing the digital signature field, I authorize the Santa Rosa Professional Educators (SRPE) to deduct dues from my bank account or the payment method I have selected, as annually certified by SRPE. These deductions will be made in equal, recurring installments, in alignment with the district payroll schedule. I hereby relinquish all rights and claims to the monies deducted and transmitted in accordance with this authorization and absolve SRPE, its officers, employees, and agents from any liability related to these deductions. This authorization shall remain in full force for the duration of this agreement, unless SRPE receives a written revocation notice from me at least thirty (30) days in advance.

I understand that by clicking the "Click to Proceed" button, I must complete the checkout process to link my chosen payment method. Membership authorization will not be considered complete until my payment method has been verified and deemed reliable for fulfilling payment obligations. I further agree that a digital signature shall be effective to prove assent to the terms of this membership application and that the terms of this application may be proved through electronic facsimile, including a scanned electronic copy in PDF or other digital format, and that the documents required by law to be retained related to membership in SRPE may be retained in digital format.

Use your finger (mobile) or mouse (desktop) to sign below.

...

Click the "Click to Proceed" button to begin the payment process. A link to the information below, along with additional details, will be sent to the email address you provide. Look for an email from srpe.noreply@santarosa.org and please check your spam folder, especially if you have a district email with tight filters.

Please ensure your email is correct, as it's our main way to contact you. If you have email issues, reach out to us at:

srpe.office@srpeducators.com

Select a preferred payment method

Banking Information (ACH)

Card (Credit/Debit)

An error occurred. Please try again.

Creating checkout session...

Fulfillment & Privacy Policies

Having any issues? Let us know.
srpe.office@srpeducators.com

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