[Full Name]
[Home Address]
[City, State, Zipcode]
[Last four digits of your social security number]
[School district]
[Local association (full local name)]

Agency Fee Rebate
CTA Membership Accounting
P.O. Box 4178
Burlingame, California 94011-4178

Dear CTA:

Pursuant to the Settlement Agreement in Apple v. CTA, Case No. 96 1904 K JFS (S.D. Cal. 1997), effective immediately, I hereby resign my membership in your union at all levels.
As a nonmember of the NEA/CTA/local association, I object to, and request a rebate of, the nonchargeable portion of NEA/CTA/local association agency fees. I expect to receive your rebate check within 30-45 days.

I also wish to challenge the NEA’s, CTA’s and local association’s calculations of their chargeable amounts in an "arbitration" hearing. I have no objection to the CTA providing my name and address to any other fee objector who seeks the identities of other fee objectors for purposes related to the upcoming arbitration case.



[Your Name]

cc: 1. Local Association President;