MRTA/ORTA Annual Dues
Application Form

Name ____________________________________________________________________________________


Address __________________________________________________________________________________


City ___________________________________________________ State ________________ Zip__________


Year Retired ______________   School District _______________________________________________


______________MRTA (Annual) $10.00                  _______________ORTA (Annual)  $30.00


______________MRTA (Life)  $50.00                       _______________ORTA (Life)  $500.00

Please make one check payable to the Mahoning Retired Teachers Association.  Your check will be deposited and we will forward the amount due to ORTA.  If you wish to have your MRTA/ORTA membership card mailed to you, please enclose a self-addressed, stamped envelope with your payment.  Membership cards can also be picked up at the luncheons.

Mail Check to:

Debra Mettee
680 Presidential Dr.
Boardman, OH  44512