BECOME AN IAHSE MEMBER!

IAHSE's Membership Consist of:  Current and former state employees who are/were employed by the state agencies, universities, boards and commissions or other entities of Illinois Govenment.  Associate membership is available to non-state employees and full time students who want to be members, but will not be able to vote or hold office. 

How to become a Member:  If you wish to join IAHSE please complete the form below and mail it to IAHSE with your payment for $36.00.  If you are currently a state employee, you may choose payroll deduction.  The amount of $1.50 will deducted from each paycheck, totaling $3.00 a month.        

    If you have any questions please contact IAHSE at:

    Phone:  312-814-8942                  Fax:  312-814-8538

    E-mail:   IAHSE.ASSOC@illinois.gov

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To use the membership form below simply copy and

paste to either a Word Perfect or Word document. 

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   IAHSE MEMBERSHIP FORM

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   ILLINOIS ASSOCIATION OF HISPANIC STATE EMPLOYEES

STATE OF ILLINOIS                  PAYROLL DEDUCTION AUTHORIZATION FORM   

I am paid _________Monthly   _________Semi-Monthly   _________Bi-weekly 

I hereby authorize a deduction in the amount certified as the current rate of

deduction to be withheld from my pay in accordance with the State Salary

and Annuity Withholding Act.   

Deduction for- ILLINOIS ASSOCIATION OF HISPANIC STATE EMPLOYEES,      74        ,

                                       Payee's Name                                Payee's Code No

Social Security # ___________________________________________________ 

NAME _____________________________________________________________ 

Home Address ______________________________________________________

City _______________________________________ Zip ____________________

PHONE (__________) ________________________________________________

Agency __________________________________ Payroll Code No. ___________

Business Address ____________________________________________________

City _______________________________________ Zip ____________________

Phone (__________) _________________________________________________

E-mail _____________________________________________________________

Initial Deduction Per:  Pay Period $_______________  Month $_______________ 

Effective Pay Period __________________ Date___________________________  

Signature___________________________________________________________

 CHECK ONE:                                                                                                 

     [ ] Payroll Deduction   ($1.50 per Pay Period)          

     [ ] Full Membership   (Pay $36.00 for one Year)                  

     [ ] Associate Member   (Pay $36.00 for Year)  

     [ ] Student/Retired Member   (Pay $25.00 for one Year)    

 Make check payable to and Return to: 

     ILLINOIS ASSOCIATION OF HISPANIC STATE EMPLOYEES

     P. O. Box 641526,  CHICAGO, ILLINOIS 60664-1526

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