IRTAPAC - Online Contribution Deduction Form

IRTAPAC
$1/month Enrollment

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

IRTAPAC is a statewide, nonpartisan Political Action Committee (PAC) organized by members of the Illinois Retired Teachers Association to benefit the entire retired educator community through political contributions to state candidates. To make a contribution, fill out the form below or send a check to: IRTAPAC, 828 S. Second St., 4th Floor, Springfield, IL 62704.

*You must be a TRS annuitant to utilize this form. If not please send a check to the address above.

Name *

First Name Middle Name Last Name

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Phone Number *

Area Code Phone Number

Personal Email (No District Emails Please) *

example@example.com

Date of Birth *

Retirement Year *

Contribution Deduction Authorization *

I hereby authorize the Teachers Retirement System to deduct $1 per month for my IRTAPAC contribution.

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

Clear

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