AREA VII
Membership Application Form - 2010

 Fill this out and then print a copy for yourself and one to mail.
 Which Division do you want to join?  Select a division Division 11 . Glendale - Foothill Division 12 . Los Angeles Division 15 . Santa Barbara Division 18 . Santa Monica Bay Division 19 . San Fernando Valley Division 28 . Ventura County Division 46 . South Bay Division 48 . Antelope Valley Division 68 . Santa Clarita
 How do you want to pay your dues?   $42 check for one member $84 check for two members $3.50 deducted from my check each month for one member. $7.00 deducted from my check each month for two members. $840 check for Life Membership

 Make checks payable to "CalRTA" and mail to the division address.
 If you chose a dues deduction option, CalSTRS will need your
 Social Security Number. (fill in only for dues deduct)

I authorize the State Teachers' retirement System (CalSTRS) to deduct my Association dues. Should the amount of dues be adjusted, as deemed necessary by CalRTA, I authorize that the adjusted deductions shall continue unless I notify the CalRTA business office in writing to the contrary.

 Signature __________________________ Date:______________
 Spouse name if joining:
 Your name:
 Address:  
 City: State:  ZIP:
 Phone: email:
 District retired from:
School retired from:

this form.     Submit