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       Join MCRTA

         Membership Form

(Please print or use an address label.)

Name (As listed with STRS)                  Phone

Mailing Address                                      City

State/Zip Code     Last four digits of S.S number  
                                     for ID purposes only 

Year Retired ______________

Were you a member of ORTA last year? _____

Are you a LIFE MEMBER of the ORTA?_______

Do you receive income from STRS/Ohio? ____

MCRTA   _________ $10.00 Annual
               _________$140.00 Life MCRTA

ORTA     _________ $30.00 Annual
               _________$500.00 Life

Choose the type of membership you would like and 
send a check payable to MCRTA at:

                     c/o Nancy McNeal 
                 1044 Brimfield Drive
                 Medina.OH 44256

          or telephone Nancy
          at 330-722-1948