ARTA Membership Application Form

Application for Membership/Renewal in the Alberta Retired Teachers' Association
11010 - 142 Street NW Suite 408, Edmonton, Alberta T5N 2R1 - Phone (780) 447-9474

Please note: we do not accept credit cards, please mail in your cheque to the above address
Please make cheques payable to ARTA

Name: (Mr/Mrs/Ms/__________________________________________________________
Miss/Sr./Dr. Surname First Name Initial Maiden

Address: ______________________ City/Town: _______________ Province ____

Postal Code _________ Phone No: __________________ Year retired: ____________

Alberta Retired Teachers Association number ___________________

ATRF Pension number or ARTA number (if known) ___________________

Are you receiving ARTA (Johnson) Benefits? ___Yes ___ No (If yes, your dues must be up to date).

__Regular Member: $15.00 for 1 year, or preferably multiple years. (effective July 1, 2005) Payable to the ARTA address above.

__Affiliate Member: $40.00 for 1 year, or preferably multiple years. (effective July 1, 2005) Payable to the ARTA address above.

**Please note: The ARTA year runs from July 1 to June 30. Memberships expire on June 30.


Signature: ____________________ Date: ____________

FOR OFFICE USE ONLY
Cheque __________ Cash __________ Year __________

ARTA © 2005