APPLICATION FOR RTAM MEMBERSHIP

Print out this form and mail it in as directed (see addresses below).
Please PRINT:     

Surname: ___________________________ Given Name(s): ____________________________________

Please check:  __Mr. __ Mrs. __Miss __ Dr. or __Other      Birth Date: year________ mm____ dd____

Mailing Address: _______________________________________________________

___________________________________________    Postal Code: _______________

Phone Number: (______)_________________   Email: _____________________@__________________

PART A: Complete only if you receive a pension from TRAF (Teachers' Retirement Allowances Fund).

TRAF Pension # ________________ (if known or see upper right corner of TRAF correspondence to you)
I understand that the RTAM membership fee will be deducted from my TRAF pension each month ($2.25).

Signature: ____________________________________   Date: ____________________________

For Part A, this application should be forwarded to:
        Teachers_ Retirement Allowances Fund  Room 330, Johnson Terminal, Winnipeg, MB R3C 4S8

PART B: Complete if you do NOT receive a pension from TRAF.

In what school or in what community did you last teach? _______________________________________

When did you stop teaching? __________  How many years (approximately) did you teach? __________

Last certificate number?: _____________ of Manitoba OR from what other province? ________________

Signature: ______________________ Date: ______________

For Part B, submit this form and the annual fee ($27 for July - June; payable to "RTAM") to:
RTAM Membership #204 - 2281 Portage Avenue, Winnipeg, MB  R3J 0M1

Be advised that RTAM is committed to respecting your privacy. We protect this privacy by maintaining personal information
in the strictest confidence and securing it using appropriate safeguards. RTAM does not share member_s  information with
other organizations without your consent.