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 Assocation 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

 

Printer Friendly Form
 
 
                                       Membership  Enrollment Form 
 
Name:____________________________________________________________________________________

Address:__________________________________________________________________________________
 
City, State, Zip Code: ______________________________________________________________________

Phone:
Area Code:_____________ – ___________ ___________________

e-mail address: _____________________ @ _________________________________
 
I worked at: (check all that apply) AgResearch___ CASNR___ CVM___ Extension___

Last UTIA Employment: Title_________________________________________________________________

Department/Location
:_______________________________________________________________________

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:
 Martha Jo Tolley, UTIA Retirees Secretary-Treasurer, 8833 Shoreham Blvd., Knoxville, TN 37922
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