RTOM FORM-MEMBERSHIP APPLICATION - Retired Teachers Organization of the NSTU

Membership / Authorization Form

Member Information to be shared with Branch Presidents:

NAME

RETIREMENT DATE

PROFESSIONAL NUMBER

DATE OF BIRTH

ADDRESS

TOWN/CITY

POSTAL CODE

HOME PHONE

MOBILE PHONE

RTO NEWSLETTER EMAIL OPTION

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The Retired Teachers Organization (RTO) is committed to respecting privacy and protecting personal information. All personal information collected is managed and maintained according to the principles outlined in the RTO Privacy Principles.

PAYMENT

I hereby authorize the monthly approved RTO membership fee deduction from the Nova Scotia Teachers Pension (presently $4/month). I can stop this deduction at any time by returning my card to the RTO. A temporary card may be issued with the permanent card to follow.

AUTHORIZATION GIVEN

SIGNATURE

Please scan/photograph and upload your signature (2 MB limit, JPEG, PNG, GIF or PDF).

DATE

BRANCH TO WHICH YOU WOULD LIKE TO BELONG