IRTA Pipeline Membership

PIPELINE
MEMBERSHIP FORM

828 S. 2ND ST | 4TH FLOOR | SPRINGFIELD, IL 62704
217-523-8488
irta@irtaonline.org | www.irtaonline.org

As a new retiree your IRTA dues are free for the years preceeding retirement (cancel anytime). Your IRTA membership supports protection of your Teachers Retirement Insurance Program (T.R.I.P.) health insurance, your pension, your cost of living adjustment (C.O.L.A.), dental and vision insurance and other benefits offered by the association. Your membership is required to keep our association sustainable and solvent. Without your membership, the association will not remain as healthy as it needs to be. Sign up below right now.

IRTA is the ONLY organization working every day, solely on the behalf of retirees.

First Name*

Middle Name

Last Name*

Street Address*

Street Address Line 2

City*

State / Province*

Zip / Postal Code*

Phone Number*

Area CodePhone Number

Personal Email (No District Emails Please)*

example@example.com

Date of Birth*

Date

Retirement Year*

Which School District will you retire from?*

Dues Deduction Authorization*

I hereby authorize the Teachers Retirement System to deduct my IRTA dues in monthly installments at an initial rate of $3.50 or as subsequently established by the Delegate Assembly.

Signature Required for Dues Deduction - (Hold Your Mouse Button While Signing)*

TRS Requires the last four digits of your Social Security Number for Identification. *