Click "Download File" to download the membership form to join CCRTA.
| p.7_membership_form_revised__2-17-2026.pdf |
Membership Form
Champaign County Retired Teachers Association (CCRTA)
Champaign County Retired Teachers Association (CCRTA)
All new retirees receive free CCRTA Membership for the fall months of September through December of the year they retire.
Continuing membership:
CCRTA Dues
Annual Dues: $10:00 Lifetime Membership Dues: $150:00
Please make checks payable to CCRTA, and give or send to:
Jan Niccum
CCRTA Interim Treasurer
3 Brian Court
Savoy, IL 61874-9444
Tear off form below, complete all information, and return with dues payment
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Champaign County Retired Teachers Association Membership
Membership for January-December of ____________. (Fill in the year)
Name (Please Print): ______________________________________________________
Address Number and Street: ________________________________________________
Address City and 9-Digit Zip Code: __________________________________________
Phone: ______________________ Email: ____________________________________
Birthdate: (Optional) __________ Grade/Subject Taught: _________________________
Year retired: ___________ School District: ____________________________________
IRTA # (if known) ______________ Amount included: __________________________
Today’s date: _____________________________
Continuing membership:
- Membership is for calendar year January through December.
- Dues are collected in the fall previous to the following membership year.
- Annual membership dues are $10.00, regardless of the month you join.
- To be listed in the printed CCRTA Membership Directory, dues must be paid by December 31 of the previous year.
- This form is for CCRTA dues only. Illinois Retired Teachers Association (IRTA) dues are sent by members directly to the state IRTA office. See www.irtaonline.org for details.
CCRTA Dues
Annual Dues: $10:00 Lifetime Membership Dues: $150:00
Please make checks payable to CCRTA, and give or send to:
Jan Niccum
CCRTA Interim Treasurer
3 Brian Court
Savoy, IL 61874-9444
Tear off form below, complete all information, and return with dues payment
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Champaign County Retired Teachers Association Membership
Membership for January-December of ____________. (Fill in the year)
Name (Please Print): ______________________________________________________
Address Number and Street: ________________________________________________
Address City and 9-Digit Zip Code: __________________________________________
Phone: ______________________ Email: ____________________________________
Birthdate: (Optional) __________ Grade/Subject Taught: _________________________
Year retired: ___________ School District: ____________________________________
IRTA # (if known) ______________ Amount included: __________________________
Today’s date: _____________________________
