Membership Form

Click right below to download and print your Membership form:

Click here to downloadand print your Membership Form.

How to read your newsletter mailing label for dues' payment information?

S=state
P=Portage

Life memberships are indicated by (life)

Example: Annual 3 means that local dues are paid through 2013 and would be due at this time for 2014.

2014 PCRTA and ORTA MEMBERSHIP FORM

Name ____________________________________________________

Retirement School/Year ____________________________________

Mailing Address ___________________________________________

City, State, Zip ___________________________________________

E-mail Address ____________________________________________

Phone ___________________________________________________

Last 4 digits of Social Security Number ______________________

Gift Membership from ________________________________________

Email Address

   I would be willing to get my newsletter by E-Mail. _____Yes    ____ No

                                                       2014 DUES PAYMENT

PCRTA & ORTA ANNUAL DUES:

(PCRTA $10 +ORTA $30) =        $ 40 __________
PCRTA Life Membership              $150 __________
ORTA Life Membership                $500 __________
Scholarship Fund Donation                 __________
TOTAL

    Make one check payable to  PCRTA. Mail the completed form and check to:

Dave Gynn
4210 Lancaster Ln. Kent, OH 44240

Any questions, Please call Dave at 330-678-8423