Print the membership enrollment form shown below, complete the information on the form and mail to the secretary-treasurer at the address listed at the bottom of the form.
New Members: Include a check payable to UTIA Retirees Association in the amount of $30.00.
Membership Renewal: Former annual members list the date of your last active annual membership.
Address Change: Include Newsletter and Update Preference
City, State, ZIP Code: ______________________________________________________________________
Phone: Area Code:_____________ – ___________–___________________
email address: _____________________ @ _________________________________
I worked at: (check all that apply) AgResearch___ Herbert___ CVM___ Extension___
Last UTIA Employment: Title_________________________________________________________________
Date of retirement ___________________________
I prefer the e-newsletter ____ print newsletter ____
Add my email address to the list serve to receive updates with information about members and UTIA events ____
New Member____ Membership Renewal (former annual member)____ New Lifetime Membership $30.00
New Members include a check payable to UTIA Retirees Association in the amount of $30.00 for lifetime dues.
Mail to: Sandie Morton, UTIA Retirees Secretary-Treasurer, 7006 Leopard Drive, #105, Knoxville, TN 37918