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.

 

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*Member No._________________

 

Last Name:______________________  First Name__________________________

 

Address:____________________________________________________________

 

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