Name * Preferred First Name Street Address * City, State, Zip Code * Home Phone * Cell Phone * Birthdate * Personal Email * Job Title * Work Location * KCPS Employee Number Approximate Date of Employment with KCPS * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026 If you are a new member, who recruited you? Please choose either the Bank Draft (Preferred Method) or Credit Card payment method below: BANK DRAFT: Bank Name Routing Number Bank Account Number Credit Card: Name on Card: Card Number Expiration Date Security Code I authorize theKCFT & SRP (Kansas City Federation of Teachers & School-Related Personnel) to deduct per-pay period dues for membership in accordance with the KCFT & SRP Constitution and bylaws and the AFT Constitution. Dues payments are not deductible as charitable contributions for federal income tax purposes. The dues amount may change if authorized according to the requirements of the local, state, or national constitutions. If this happens, I authorize my bank or credit card to adjust my monthly payment when notified by KCFT & SRP. I understand that annual dues are divided into the same number of payments as my annual salary, and that these deductions shall be made at the same time as each paycheck and continue until KCFT & SRP is given written authorization of revocation, unless the written notice is between April 16 and the beginning of the nest school year. In that case, dues will be stopped after the last paycheck of the school year in which the written notice is tendered. If KCFT & SRP is unable to deduct said dues from my bank account, or if the need to switch otherwise arises, I hereby authorize the Board of Education of Kansas City Public Schools to deduct from my salary such amount as may be necessary to pay my regular Membership dues in the KCFT & SRP as are now or may hereafter be fixed by the Constitution of KCFT & SRP, said deductions to be deducted in equal installments during each school year and remitted to said KCFT & SRP. 2019-20 dues amounts per pay period: Certified: 40.00 12-month Classified: 20.00 10.5-month Classified: 22.85 Please type your name to sign * Leave this field blank