MRTA/ORTA ENROLLMENT FORM

Name ____________________________________________________________________________________


Address __________________________________________________________________________________


City ___________________________________________________ State ________________ Zip__________

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

Phone ___________________________________  Cell____________________________________________

Email Address _____________________________________________________________________________


Year Retired ______________   System _______________________________________________


______________MRTA  2025 ($20)                 _______________MRTA Life ($75)


______________ORTA 2025 ($30)                    _______________ORTA Life ($500)

Please make one check payable to the 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