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:

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

          or telephone Nancy at 330-722-1948