UTD Retired Payment Form
Retired Chapter
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Employee Number (If is not known write"Retired")
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
One-Time Payment Options
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Retired Full Time Teachers
Yearly membership payment.
$
94.00
Retired Full Time ESP
Yearly membership payment.
$
70.00
Retired Full Time Teachers Lifetime
If you already have a lifetime membership
$
48.00
Retired Full Time ESP Lifetime
If you already have a lifetime membership
$
24.00
Lifetime Memebrship Fee
First payment of Lifetime membership.
$
400.00
Retiree Event Member
Buy a Ticket to a Retiree Event Members
$
30.00
Retiree Event Non Member
Buy a Ticket to a Retiree Event Non Members
$
35.00
Credit Card
Payment Authorization
Your membership dues will be charged to your credit/debit card in the amount you chose on this form. By filling out this form, I am authorizing the United Teachers Of Dade to charge my credit card for the retired chapter's annual dues. I understand that the payment of my dues will make me a member of the retired chapter for a full calendar year. My membership will start from the date of this payment and will last until a full calendar year later.
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I have read and agree to the terms presented in the Payment Authorization section above.
Signature
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