Membership Form
Name: ______________________________________________________
Last
First ___________________ Initial ______
(as it appears on pension check)
COMPLETE ADDRESS: ________________________________________________________
_______________________________________________________
Phone: ________________________
Email: ___________________________________________________________________
Were you a member of ORTA in 2008? _______ Did you receive income from STRS of Ohio? _______
Year Retired? _______
ORTA Annual Dues $20 _____________ ORTA Life Dues
$300 ____________
Local RCRTA DUES $5 ______________ Local Life Membership
$50 ___________
Dues may be paid at regular meeting or by mail.
Send check to :
Ruth Nichols, RCRTA Treasurer
1168 Cobblefield Drive
Mansfield, OH 44903
ORTA dues will be
forwarded to Columbus.