Last Name______________________________ First Name____________________________
Address_________________________________________________________________________
City____________________________________ State_________ Zip______________________
Home Phone___________________________ e-mail_____________________________________
Are you an IRA Member? yes____ Number________________ no____
Position/Level_______________________________________________________________________
School__________________________________ School Phone_____________________________
Dues: Local & AZ $30.00 Student $15.00 Retired $15.00
Mail to: Membership, 5441 E. Burns, Tucson, AZ 85711
Contact: Shirley Duffy, shdted@aol.com