Everett Coaches & Extracurricular Association

Dues Form 2019

Name: __________________________ ____________________

Please Print Employee ID #

I hereby request and submit my membership in the Everett Coaches and Extracurricular Association and authorize union membership dues to be withheld from my salary each pay period and transmitted to the treasurer of the Association. I agree that this authorization for payroll deduction shall be automatically renewed each year thereafter unless written notice of revocation is given by me to the Association as provided for in the collective bargaining agreement and the By-Laws of the Association. Union dues are currently ½ of 1% of your total stipend and may be adjusted from time to time by the Association (for illustrative purposes, a person receiving a $5,000 stipend would pay dues of $25).

Signature: ____________________________ Date: ________________

Mailing Address: ___________________________________________

City: __________________________ State: ________ Zip: _________

Home Phone: ( ) ________________________

Cell Phone: ( ) ________________________

Work Phone: ( ) ________________________

Work e-mail: ____________________________

Home e-mail: ____________________________

Please send completed form to

Brian Sachse/Eisenhower Middle School

If there is a concern with becoming a member of our association, please contact Brian Sachse at 425-385-7542 or email him at bsachse@everettsd.org

You may also contact Shelly Lamb our Administrative Assistant at the EEA office: slamb@washingtonEA.org

Thanks, your friend in coaching & activities. Brian L. Sachse