DCRTA/ORTA ENROLLMENT FORM
Enclosed is my check payable to: ORTA - for ORTA membership (includes DCRTA local membership) and/or DCRTA - for Delaware County Retired Teachers Association membership only. DCRTA will also be happy to accept either of these checks at any DCRTA meeting.
Enclosed (please check memberships you are purchasing):
___________ DCRTA Local Chapter Annual Dues ($15.00)
___________ ORTA Annual Dues for First year membership- which includes DCRTA local dues ($40.00
___________ ORTA Renewals ($30.00)
___________ ORTA Lifetime Dues ($500.00)
_______________________________________________ ______________________
Name (Please print as shown on STRS Check) SS# last four digits
___________________________________________________ __________________
Mailing address (Where to send correspondence) Area Code and Phone Number
__________________________________________ _____________________________
City, State and Zip Code E-mail address
From what School District did you retire? ____________________________________
When? _______________
ORTA member last year? Yes ____ No _____
Local chapter association member last year? Yes _____ No _____
If yes, name of chapter _______________________________________________
Mailing address:
ORTA
250 E. Wilson Bridge Rd
Columbus, Ohio 43085
Enclosed is my check payable to: ORTA - for ORTA membership (includes DCRTA local membership) and/or DCRTA - for Delaware County Retired Teachers Association membership only. DCRTA will also be happy to accept either of these checks at any DCRTA meeting.
Enclosed (please check memberships you are purchasing):
___________ DCRTA Local Chapter Annual Dues ($15.00)
___________ ORTA Annual Dues for First year membership- which includes DCRTA local dues ($40.00
___________ ORTA Renewals ($30.00)
___________ ORTA Lifetime Dues ($500.00)
_______________________________________________ ______________________
Name (Please print as shown on STRS Check) SS# last four digits
___________________________________________________ __________________
Mailing address (Where to send correspondence) Area Code and Phone Number
__________________________________________ _____________________________
City, State and Zip Code E-mail address
From what School District did you retire? ____________________________________
When? _______________
ORTA member last year? Yes ____ No _____
Local chapter association member last year? Yes _____ No _____
If yes, name of chapter _______________________________________________
Mailing address:
ORTA
250 E. Wilson Bridge Rd
Columbus, Ohio 43085
