UNT Retiree Association - New Member Registration

Personal Information  
Please provide your information below:
Salutation (Mr., Mrs., Dr., etc.)
First Name
Last Name
Retired from UNT department/unit:
Position
Year of retirement
Address Line 1
Address Line 2
City
State
ZIP
Daytime Phone
Evening Phone
Cell Phone
Email Address

UNTRA Membership 2017-2018
Members will receive free updates from UNTRA about upcoming events and other opportunities.
Registration Details
   Fee
UNTRA Membership - Individual Retiree   20.00
UNTRA Membership - Couples' Rate   30.00
UNTRA Membership - New Individual Retiree   0.00
UNTRA Membership - New Retiree Couple   0.00
Membership Details
If your spouse/partner is also a UNT retiree, please choose the couples' rate above and provide your spouse/partner's personal information below:
Enter your spouse/partner's full name here: (include salutation: Mr., Mrs., Dr., etc.)
Spouse/partner's department/unit: (if applicable)
Spouse's Year of Retirement

Do you have easy access to the internet? Yes
  No

Are you able and willing to receive UNTRA updates by E-mail? Yes
  No

What are your special interests?
= required field