Name(as on STRS account)__________________________________________

Address____________________________ City_______________ Zip________

Phone__________________________ Cell______________________________

Retirement Year__________  Total Years in Education________

Birthdate _________________

Spouse __________________________
 
Your email ____________________________________

Alternate address(summer   winter)____________________________________

          Regular Member________                  Associate Member_______

          Annual Dues:  $45
            (Please write 2 checks:  one for HCRTA  and one for ORTA)

                   HCRTA....$15 Annual Dues

                   ORTA.......$30 Annual Dues

          LIFE MEMBERSHIP (Also 2 checks needed as above)   $550

                   HCRTA......$50 Life Member

                   ORTA........$500  Life Member

_____Community Service Project          _____Community Volunteer Hours  

_____Courtesy                                       _____Reservations/Call Chain                      

_____Information Services                    _____Legislative

_____Retirement Planning                    _____Public Relations/Newletter

_____Membership                               _____Historian