Membership / Authorization Form

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Name

Professional #

Date of Birth

Address

Town / City

Postal Code

Phone #

Email

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Newsletter

Please check this box if you prefer to receive The Retired Teacher newsletter by email instead of regular mail.

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Payment

I hereby authorize the monthly approved RTO membership fee deduction from the Nova Scotia Teachers Pension (presently $3/month). I can stop this deduction at anytime by returning my card to the RTO. *A temporary card may be issued with the permanent card to follow.

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Branch to which I prefer to belong Annapolis Halifax CPX Pictou Antigonish/Guysborough Halifax City Queens AER-Baie Sainte-Marie (Clare) Halifax County Richmond Colchester-East Hants Inverness Shelburne Cumberland Kings Sydney & Area Dartmouth Lunenburg West Hants Digby New Waterford Yarmouth/Argyle Glace Bay & Area Northside–Victoria Out-of-Province

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If the form does not work properly on your computer, click here for the printable PDF version of the form