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

Associate Membership / Authorization

An associate member is a surviving spouse / partner of a retired teacher

NAME

DATE OF BIRTH

ADDRESS

TOWN/CITY

POSTAL CODE

PHONE

PLEASE PROVIDE

NAME OF DECEASED SPOUSE OR PARTNER

PROFESSIONAL # OF SPOUSE OR PARTNER

EMPLOYMENT # OF SPOUSE/PARTNER IF RETIRED NSCC MEMBER

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

Associate members have the full rights, privileges and responsibilities of membership except in matters of voting and holding office of the Organization and are entitled to all the rights and privileges accorded to active members such as:

• Deals and Discounts
• Travel Club & Home & Auto Insurance
• Health (Medavie / Blue Cross)

Please check our web site at rtonstu.ca for additional information or call 1-800-565-6788 or 902-477-5621 in the Metro area.

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