Page 7

CTA

cta Choose your membership type and payment option: Basic - $150 _____ First Year Teacher - $80 _____ Associate - $30 _____ _____Payment by check.(mail to: 4900 Unaka Ave, Charlotte NC 28205) _____Payment via PayPal.(at www.ctanc.org using the “Payments and Donations” button) _____Monthly payments of $12.50 viaautomatic bank draft. (You must complete the authorization section below to enroll in this service. The first payment will occur on the 1st day of the month following enrollment and will continue on the 1st of each subsequent month. Your coverage/membership and payments will roll automatically into each subsequent term unless CTANC receives notice that you wish to cancel. All requests for cancellation will be processed within one business day.) Name: Address: Home Phone: Cell Phone: Home Email: School Email: School: Position: Referred By: Authorization for dues payments via Automatic Bank Draft: Please debit payments from my (check one): Checking (must include voided check) Savings (contact your bank for routing #) Date of first payment: ______/______/______ Payment Amount: $_______________ Payment Frequency: Monthly on the 1st Agreement I authorize CTANC to process debit entries to my account. I understand that this authority will remain in effect until I provide reasonable notification to terminate the authorization. Authorized Signature: Date:


CTA
To see the actual publication please follow the link above