Salary Request Form 2019 Dues Name* First Last Email* Employment StatusI am EmployedI am a full dues paying member of the ACCI am RetiredI am currently receiving less than $11,500.00 income from a Cantorial, Jewish Professional or Communal Position*If you check off any statements for this question, other than "I am Employed", you need not respond further*My annual income from salary and parsonage from a Cantorial, Jewish Professional or Communal Position (not including pension and health insurance payments) at this time is: (Please note, minimum CA Dues, unless classified as "Retired," for anyone earning $11,500 or less, is $150 per year.) I am a joint member of the JEA. My current JEA dues are: (we will deduct 20% of JEA dues paid from Cantors Assembly dues assessment)I am a joint member of the RA. My current dues assessed by the RA are: (half of dues assessed by the RA are paid to the RA; half are paid to the CA) FULL MEMBER (please fill out in box) FULL MEMBER __________________ (Figure Listed Above)(multiplied times .013) = ___________________________ (Your Dues for the Coming Year) CICA MEMBER (please fill out in box) CICA MEMBER __________________(Figure Listed Above)(multiplied times .01) = ___________________________ (Your Dues for the Coming Year) As an aid to those members whose dues are paid by their synagogues, we will, only with your signed permission, send copies of dues invoices and statements, both hard copy and electronic, to a second party. Please complete the following: I hereby request the Cantors Assembly send copies of all invoices and statements relative to my Cantors Assembly dues to the following:Please list name, position, email, and mailing address of the person you would like to receive a copy of your dues invoice.
