Your Name (required)

Title (required)

Office Number (required)

School/Division (required)

Position (required)

Employee ID Number (required)

Personal Mailing Address (required)

Personal Email (required)

Select JCAA Membership Level:

General Member - $45 per month - For Licensed and Classified Jeffco Administrators and Professional/Technical Positions."

Associate Member - $22.50 per month - For Non-Administrative Educational and Professional Jeffco Employees."

Desired Payment Method:

Monthly Salary Deduction"

Bill Me Annually"

Membership Authorization:

I authorize the District to deduct the above monthly amount from my salary or wages and transmit the same to JCAA. I further understand dues will only be collected up to the month when I leave the District's employment. This authorization and assignment shall remain in continuous effect without the need for renewal each fiscal year, unless and until revoked by me in writing delivered to the JCAA office.

I agree to the terms of my selected payment type."

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