Test Form

First Name

Last Name

Middle Initial

Personal Email

Street Address

City

Postal/Zip

Apartment/Suit

Phone

I hereby authorize the Santa Rosa Professional Educators (SRPE) to deduct from my bank account specified above, dues as annually certified by said SRPE, in equal recurring deductions (corresponding with the district payroll schedule), based on my salary amount (30k or more= $46.15/mo. and 29,999k or less= $24/mo). I hereby waive all right and claim to said monies so deducted and transmitted in accordance with this authorization and relieve SRPE and all its officers, employees, and agents from any liability thereof. This authority shall remain in full force and effect for all purposes for the duration of this agreement, or until receipt of thirty (30) days written revocation notice to SRPE.

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srpe.office@srpeducators.com

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

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