Forms

TRTA/GPRSP MEMBERSHIP ENROLLMENT FORM

2018-2019

New member______                Renewing member _____

Name____________________________________ Date of birth___/___/___

 

Address________________________________________________________

 

City________________________ State_______ Zip_____________

 

Phone___________________________ Email_________________________

 

School(s) where I worked in GPISD ________________________________________________

 

I did not work in GPISD.  I worked in _______________________________________________

 

I receive an annuity from a teacher retirement system.    ___Yes     ___No

 

TRTA/GPRSP membership year is July 1, 2017 – June 30, 2018.

Membership dues are not tax-deductible.

 

State dues: $35.00                   Local dues: $10.00           Total: $45.00

If you are paying both state and local dues, you may pay cash ($45.00) or make your check ($45.00) payable to GPRSP.  The treasurer will be responsible for sending your dues to state.

If mailing your dues (checks payable to TRTA/GPRSP only), please send to:

Grand Prairie Retired School Personnel

PO Box 530344

Grand Prairie, TX   75053

 

Payment options:

 

#1____I am a TRTA Diamond member, and/or my state dues are payroll deducted. I am paying local dues only ($10).  _____Cash or ____Check #________                               

 

#2____I am paying state and local dues ($45) in Cash or Check #_________.

 

#3____I have sent state dues into TRTA.  I am paying local dues ($10) only.

                 _____Cash or _____Check #_________