MRTA/ORTA Annual Dues
Application Form

Name ____________________________________________________________________________________


Address __________________________________________________________________________________


City ___________________________________________________ State ________________ Zip__________

Birth Date  -------------------------------------------------------------------------------------------------

Phone ___________________________________  Cell____________________________________________

Email Address _____________________________________________________________________________


Year Retired ______________   System _______________________________________________


______________MRTA (Annual) $20.00                  _______________ORTA (Annual)  $30.00


______________MRTA (Life)  $75.00                       _______________ORTA (Life)  $500.00

Please make one check payable to the Mahoning Retired Teachers Association(MRTA).  Your check will be deposited and we will forward the amount due to ORTA.    

Mail Check to:

Debra Mettee
680 Presidential Dr.
Boardman, OH  44512