For Automatic Dues Deduction Beginning July 1 of each year

If you wish to have your dues withheld from your July, annuity payment, sign and date the authorization below.  Once you have signed up for automatic deduction your membership remains in effect until you cancel it. You DO NOT have to renew on an annual basis.

Preferred Method:
_____"I request voluntary withholding for annual membership dues in NDRTA from my July annuity payment from the North Dakota Teachers Fund for Retirement.  This authorization will remain in effect until I choose to terminate by written notice to the North Dakota Teachers Fund for Retirement prior to June 15 of any year".

Signature (required for payroll deduction)_________________________________    Social Security Number (required for payroll deduction) _______________________________

OR

_____I Wish to Pay Membership Dues on an Annual Basis $24.00 Payment is Enclosed - Payable by July 1st of Each Year