Standard Membership Form


Harrison County Retired Teachers Association


Time to renew Retired Teachers Association dues for 2014-2015

State Dues $35.00

Local Dues $  5.00

Total Dues:  $40.00 

If dues are received by August 1 your name will be printed in the 2014-2015 yearbook.



*Member No._________________


Last Name:______________________  First Name__________________________




City:___________________  State:______________ Zip_____________________


Phone No.___________________________  * Membership Code:    M    CM    L


E-mail address:_______________________________________________________


Do you want to be called each month about the meetings?  _____________   


*Payment Type:   Cash________   *Check No.__________________________


*Date Paid:__________________


*Items will be completed by the treasurer