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Membership Application Form

bullet Membership Benefits

To join NYSTRA, complete this form, print it out on your computer, and mail with a check to the address shown below.

original application renewal

Name:
Mailing Address:
Mailing Address 2:
City:
State:
Zip:
Home Phone:
Work Phone:
Fax:
e-mail:
Employer/School:
Population:
Certification(s):
CTRS other:


Membership Fees:

  1 year     2 years
Professional $55  $100
Associate $50 $  90
Student $15 $  30
Retired $25 $  40
Retired Lifetime $120  
Organizational $125 $240

-Professional members are required to include a copy of their current CTRS certification card with renewal


-Student members are required to include a transcript or letter from advisor as proof of full-time student status

For Organizational Membership (list 5 staff who are eligible to attend conferences and workshops at member-rates)

1.
2.
3.
4.
5.

Additional contribution: $

NYSTRA now accepts credit cards!

Please fill out the following if paying by credit card:

Please check one:  __Visa __MasterCard

Name as it appears on card: ___________________________________

Card Number: ____________________________________________

3-digit security code: ________________  Expiration Date: __ __ / __ __

By signing below I do hereby authorize NYSTRA to charge $___________ to the above Visa/MasterCard Account

Signature (required): ______________________________________Date: _______________

Please send application and credit card information or check, or money order payable to NYSTRA to:

NYSTRA
P.O. Box 179
Riverdale Station
Bronx, NY 10471

(please allow 6-8 weeks for payment to be processed)