MEMBERSHIP
APPLICATION
mail to:
RETIRED
TEACHERS ASSOCIATION of CHICAGO
SUITE 1500
20 East Jackson Blvd.
Chicago IL
60604-2235
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) ......... $30.00
».. ENROLL ME AS A NEW MEMBER ......................................................... $30.00
».. ENROLL ME AS A LIFE MEMBER ........................................................ $200.00
».. Lifetime membership at age 85 or over.......................................................... FREE
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!