Membership Form - ALLEN COUNTY RETIRED TEACHERS ASSOCIATION

ALLEN COUNTY RETIRED TEACHERS ASSOCIATION

join US -
2023 ALLEN COUNTY
RETIRED TEACHERS ASSOCIATION
Jan. 1, 2023 to Dec. 31, 2023

ACRTA $12.00 ____
ORTA $30.00 _
GRANT $_ DONATION (optional)
**Over 90 years old - Dues are Free
Date paid
Cash Check #

This information is for our directory and contact list.
Name:______________
Address:
City: State:_ Zip Code:_Phone:
EMAIL________________
Birthday: (mo.)_(day)_
School Retired From:_____________________

Please complete this form and return with cash/check written to ACRTA.

Send to:
Norma Penn
809 Brendonwood Dr.
Lima, Ohio 45801

   Welcome to the ACRTA!

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