Texas Instruments Retiree Club of Houston

Application for Membership

 

TI’ERS NAME: _______________________________________________   SPOUSE: ____________________

 

STREET ADDRESS: ____________________________________________________________________________________________

 

CITY: ______________________________________________   STATE: ____   ZIP: ____________

 

EMAIL ADDRESS: ___________________________________________________________________

 

PHONE NUMBER: _________________________________________________

 

HOW DID YOU LEARN ABOUT THE CLUB? ________________________________________________________________________________________

 

HOW MANY YEARS DID YOU WORK AT TI? ____________________________


CAN WE EMAIL A COLOR COPY OF OUR NEWSLETTER TO YOUR HOME EMAIL ADDRESS? YES____ NO___
HOME EMAIL:_____________________


--------------------------------------------------Below Only for Club Treasurer Use--------------------------------------------------------

 

AMOUNT PAID: __________   DATE: ____________      CHECK NO. ____________

 

 

Print a copy of this form and mail it, along with your check for $10 made out to H.T.A., to the club treasurer. Dues are $12 if renewing after March 31.

 

        Mike Magliola

        3910 Plum Hill Lane

        Missouri City, TX 77459

 

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