Indiana Retired Teachers Association Membership Name______________________________________________________________________________________ (Last) (First) (Middle)
Street____________________________________________________ Birth Date________________ City _______________________________State_____ Zip___________
Teacher’s Retirement Fund # ______________________ Telephone Number (_____)___________________ Email________________________________________
To accurately represent our members at the state level, the Indiana Retired Teachers’ Association would like to know which county your local association is in: _________________________________________
Please check the Membership Plan that you wish to join and include payment and any additional information that your membership choice requires. $2.00 of your dues, each year will be applied to your annual subscription to the IRTA newsletter, The Bulletin Board. Dues payments to IRTA are not deductible for income tax purposes.
___Associate Membership-For any active teacher or supporter other than a recipient of a pension from Indiana State Retirement Fund. ____$10.00 per year ___$18.00 for 2 years ___$24.00 for 3 years
____Regular Membership –For any recipient of a pension from the Indiana State Teachers’ Retirement Fund. ____ $35.00 per year____ $90.00 for a 3-year membership____ $140.00 for a 5-year membership ____
Automatic Dues Deduction Authorization (Please complete the section below) Social Security #___________________ Retirement Date______________ Automatic Dues Deduction occurs September 1 each membership year at the rate of $35.00. The Membership Year is Sept. 1 through Aug. 31. If you are signing up for membership after July 15 for the current membership year, please include a $35.00 check for the current year’s dues.
____Life Membership- For any active teacher or recipient of a pension from the Indiana State Teachers’ Retirement Fund. ____Full Payment ____First Installment of 3-Year Plan _____________ Age Full Payment or 3-year payment plan/service charge Total 50 or under $700.00 or 3 installments of $244.00 ($732.00) 51-74 $550.00 or 3 installments of $194.00 ($582.00) 75 and over $350.00 or 3 installments of $127.00 ($381.00)
*Money paid, in full or in installments, for a Life Membership is not refundable due to death or disability or other reasons.
_____I want the IRTA newsletters, Bulletin Board and Legislative Updates mailed to me, instead of being sent electronically.
Checks should be made payable to: Indiana Retired Teachers Association 2629 Waterfront Pkwy., East Drive, Suite 105 Indianapolis, IN 46214