Fillable REGISTRATION FORM ATRS USE ONLY Entering T-DROP (4:00 (Arkansas Teacher Retirement System)

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REGISTRATION FORM ATRS USE ONLY Entering T-DROP (4:00 (Arkansas Teacher Retirement System)

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Mail: ARKANSAS TEACHER RETIREMENT SYSTEM
1400 WEST THIRD STREET
LITTLE ROCK, AR 72201
Email: workshop@artrs.gov
Fax: (501) 682-2359
Entering T-DROP (4:00 - 5:00 PM)
Notice: Mail, e-mail or fax registration form to ATRS using contact information below.
CHECK BOX IF NEW MAILING ADDRESS
NAME:
STREET or P.O. BOX #:
CITY:
EMPLOYER:
SIGNATURE:
Check the Appropriate Box(es)
Retirement (Not in T-DROP) (5:00 - 6:00 PM)
Retirement (In T-DROP) (6:00 - 7:00 PM)
Bringing a Guest
form to receive information at the workshop. Copy this form and send with registration.)
STATE: ZIP:
ATRS USE ONLY
Beneficiary Form #4
Beneficiary Form #9
Birth Certificate
Social Security Card
SSN:
PHONE NUMBERS: WORK
HOME CELL
E-MAIL:
DATE OF BIRTH:
(If guest is a member, they must complete a separate registration
FORMS & DOCUMENTS ON FILE
REGISTRATION FORM
REGISTRATION FORM
WORKSHOP LOCATION:_________________________________________
DATE:_________________
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REGISTRATION FORM ATRS USE ONLY Entering T-DROP (4:00 (Arkansas Teacher Retirement System)

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Completed 12 August 2020

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