LAKE COUNTY RETIRED TEACHERS ASSOCIATION

MEMBERSHIP FOR THE 2009 CALENDAR YEAR

Active Membership		Associate Membership*
___ ANNUAL DUES	$  15.00	___ ANNUAL DUES	$  15.00
___ LIFE DUES	$150.00	___ LIFE DUES	$  75.00
(please check your choice)

*Associate membership is available to individuals who are not participants in TRS but wish to support our efforts to help retired educators. It is usually purchased by the spouse of an annuitant.

PRINT NAME: ______________________________________________________

ADDRESS: ________________________________________________________

CITY: __________________________________ STATE: _____ ZIP: __________

PHONE: (_____)________________   E-MAIL: ___________________________

YEAR RETIRED ______________ FROM DISTRICT ___________

If you have any questions, call 847/623-9497, 847/970-0169, or e-mail HouleTeach@aol.com

Return this form with your check payable to:

LCRTA
PO BOX 8107
GURNEE, IL 60031

NOTE: The above dues application form is for your local (LCRTA: Lake Country Retired Teachers Assoc.) dues ONLY!! If you are also interested in joining the state organization, the ILLINOIS RETIRED TEACHERS ASSOCIATION, please contact the IRTA office in Springfield, at 800-728-4782, or log on to our website at www.lcrta.com and click on the link to IRTA for further information.

LAKE COUNTY RETIRED TEACHERS ASSOCIATION
PO BOX 8107, GURNEE, IL 60031