IRTA Pipeline Membership

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

NEW RETIREE ENROLLMENT FORM

As a new retiree, your IRTA dues are free for 2026 if you sign up to have them deducted from your TRS pension starting in January 2027 (cancel anytime). Your IRTA membership supports protection of your Teachers Retirement Insurance Program (T.R.I.P.) health insurance, your pension, and your cost of living adjustment (C.O.L.A.) 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.

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

40,000 MEMBERS STRONG!

First Name*

Middle Name

Last Name*

School District Email Address

example@example.com

Personal Email (No School Emails Please, Put Personal Email Here.)*

example@example.com

Street Address*

Street Address Line 2

City*

State / Province*

Zip / Postal Code*

Phone Number*

Area CodePhone Number

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. (cancel anytime)

Signature Required for Dues Deduction - (Hold your mouse button, use your stylus, or use your finger to sign.)*

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

Please verify that you are human*