IRTA Pipeline Membership

IRTA Free Calendar Year
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 2022 if you sign up to have them deducted from your TRS pension starting in January 2023 (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 *

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 Code Phone 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 $2.50 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.) *

Clear

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

Name of your TRS Beneficiary (if known)

First Name Last Name

Email of TRS Beneficiary

example@example.com