MEMBERSHIP APPLICATION
mail to:
RETIRED TEACHERS ASSOCIATION of CHICAGO
SUITE 2010
111 N. Wabash Ave.
Chicago IL  60602-2949

Enclosed Is my check or money order for $____________________

PLEASE MAKE CHECK PAYABLE TO RTAC AND ENCLOSE WITH THIS FORM.

».. RENEW MY ANNUAL MEMBERSHIP (January 1 - December 31) ......... $50.00

».. ENROLL ME AS A NEW MEMBER ......................................................... $50.00

».. ENROLL ME AS A LIFE MEMBER ........................................................ $200.00 ($300.00 after 1/1/2014)

Name___________________________________________________________

Street Address____________________________________________________

City_____________________________ State______ ZIP__________________

Date of Birth___________________ Phone_____________________________

Retired In Year._________________ Position____________________________

From__________________________________ (Name of Chicago Public School)

 Social Security Number__xxx-xx-____________________(Only need last 4 digits)
           (For verification purposes - your confidentiality is assured.)

Non-CPS E-mail address______________________________________
   (remember that you will  lose your CPS e-mail when you retire)

OUR THANKS FOR YOUR-SUPPORT!

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