Regular membership is available to:

California employees in a district or other educational agency designated or functioning as:

n Management employees
n Members of the management team
n Administrators with regular part-time teaching responsibilities
n Confidential employees, classified or certificated supervisory employees
(No person shall be eligible for Regular Membership who is represented by an exclusive bargaining representative, except for certificated supervisory and classified
supervisory employees whose positions have previously been designated by the employer as management or who are functioning as management.)

Professors of Education
Employees of the California Department of Education (CDE) or
Connect with us! Commission on Teacher Credentialing (CTC)
Get connected to educational leaders across the state
through ACSA’s myriad social media offerings or visit
us at www.acsa.org

2020-2021

Membership
ASSOCIATION OF CALIFORNIA
regular Application
SCHOOL ADMINISTRATORS

Here’s what’s in it for you!

n Free Professional Liability Insurance and $10,000 Accidental Death Insurance!
n Invaluable legal assistance for work-related concerns. Access to veteran administrators knowledgeable about the Educational Codes and your due process rights.
n Continued learning opportunities for brand new and seasoned leaders. Skills training on the latest trends and hot topics in education.
n Timely award-winning publications that keep you informed about issues and resources throughout the state and the nation.
n Professional connections with colleagues throughout the state. An established and growing network of leaders with savvy and practical advice for every situation.
n A strong lobbying voice for school administrators and timely electronic legislative alerts.
n Hot jobs delivered to you through weekly issues of EdCal. Jobs are also available right at your fingertips at www.acsa.org
n National and state awards and recognition.
n Exceptional member benefits that save you time and money.
Plus... You are eligible for membership in ACSA’s national affiliates.
 2 0 2 0 - 2 0 21 R EG U L A R M E M B E R S H I P A P P L I C AT I O N
2020-2021 dues
Curtis Dues prorated for the number of months remaining in the school year for members joining after July 2020. SRC: ________________
First Name M.I. Annual salary as of June 30, 2020 $________________
You are immediately covered by: Dues calculation x.0090 Rebecca McHaney
Bennett Referred By (please print one name only)
ACSA dues amount (maximum $1,525) $________________
Free Professional Liability Insurance and Last Name
ACSA PAC* +$78.00
Contributions to support ACSA's political activities are not tax deductible. ACSA
retains sole discretion over use of member political contributions. Dues may be
$10,000 Accidental Death Insurance Program Specialist Total ACSA dues $________________ deductible as business expenses. ACSA estimates that the non-deductible portion
(Regular members only) Position/Title ❏ *Check here if you do not wish to contribute $78 to ACSA’s Political Action Committee. of dues allocable to lobbying is 13.3 percent.

5915 Check below to become a member in one of ACSA’s official affiliates.

You are also eligible for all Last Four Digits of Social Security Number
CA Association of African American Superintendents/Administrators (CAAASA). . . . $500 (Supt.)/$100 (Other Admin) National Association of Elementary School Principals (NAESP). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $235

member benefits including: business

National Association of Secondary School Principals (NASSP). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$250

n In-depth reporting and features through EdCal and Subtotal Affiliate Dues $
Leadership Magazine Madera Unified School District
n Timely news and practical information from ACSA News online District payment options
at www.acsa.org
n Reduced registration to the Leadership Summit.
Special Services Department
School
SELF PAY (select one) DISTRICT/COUNTY OFFICE PAYS
n Life, accident, disability and cancer insurances ❏ Payroll deduction* If choosing this option, send form to district for authorization and
1820 Howard Road
n Auto/homeowners and personal umbrella liability coverage Address payment. This section must be completed by district or county office.
n Discount purchasing
Madera CA 93637 Signature (required for payroll deduction) Please indicate:
✽ I agree that my dues will be deducted by my payroll office. This
City State ZIP authorization shall be in effect until revoked by written notice from myself
❏ ACSA Dues (excluding $78 PAC) ❏ Affiliate Dues
or ACSA. I consent to the adjustment of such deduction to reflect any change ❏ District P.O. or check enclosed
559
( ) 416-5867 ( ) in the dues of which the payroll office may be advised by the organization.

local
❏ Bill district monthly
Work Phone Extension ❏ Three equal installments (Enclose first payment. Not offered after September 2020.) Rebecca McHaney
curtisbennett@maderausd.org ❏ MasterCard/Visa (full payment only) ❏ Check (full payment only) Authorizing party (please print)

representation 559 416-5845

Work Email Address ( )
Card Number Exp. Date Phone number
Curtiswbennett@gmail.com normaorozco@maderausd.org
Personal Email Address (Required) Email Address
Signature (required for credit card charge) Date
ACSA’s Membership Recruitment Team provides assistance ❏ Check here if you do not wish to receive ACSA email at your work email
to region leaders and region membership chairs in developing
home your job classification
goals and identifying non-members in districts within their ❏ Certificated management and supervisory ❏ CDE or CTC (Associate Membership optional) Are you represented by an exclusive
Please detach and retain for your records.

862 Bolinas Way

❏ Certificated management & teacher (dues based on admin salary) ❏ Professor of Education (Associate Membership optional) bargaining representative?
service areas. The Membership Recruitment Team also promotes Address
❏ Classified management and supervisory ❏ Charter School Administrator ❏ Yes ❏ No
the value of ACSA membership to all administrators and to Madera California 93637 ❏ Confidential as recognized under EERA ❏ Other
City State ZIP
those new and aspiring. They are available for presentations The information requested below will remain confidential and will be used for ACSA purposes only and will not be sold to
( ) 509
( ) 953-2000 vendors or any third parties.
on member benefits and services and are a tremendous Home Phone Cell Phone year of birth gender orientation education level
resource of information. To find out how you can contact ❏ Opt-in to receive text messages from ACSA. _____________________
1973 ❏ Male ❏ Female ❏ LGBT ❏ Master’s Degree ❏ Doctorate

Preferred Mailing Address ❏ Home ❏ Work ❏ Decline to State ❏ Other

your local Membership Recruitment Team member, please call
❏ Check here if you wish to view ACSA publications online only. ethnicity social media
the Member Services Department at 800.608.ACSA or email ❏ American Indian or Alaska ❏ Vietnamese ❏ Hawaiian ❏ Hispanic or Latino ❏ Facebook ❏ Instagram
Native ❏ Asian Indian ❏ Guamanian ❏ African American, not ❏ Twitter handle
For further details, call the ACSA Member Services
memberservices@acsa.org. Department at 650.692.4300 or 800.608.ACSA(2272)
❏ Chinese ❏ Laotian ❏ Samoan of Hispanic origin
__________________________________
❏ Japanese ❏ Cambodian ❏ Other Pacific Islander ❏ White, not of Hispanic origin
Fax 650.437.9189 • Email memberservices@acsa.org ❏ Korean ❏ Other Asian ❏ Filipino ❏ Decline to State