Membership Application Form

Prefix Select Mr. Ms. Mrs. Miss

First Name        Last Name     Middle Initial

Street Address

City       State     Zip

Home Phone     Work Phone     Mobile Phone

Contact Select Weekday Weekend Any time     Time Select morning afternoon evening

E-Mail

Graduation Year     Degree Select B.A. B.S. B.B.A M.B.A Ph. D. Masters Other

Employer      Profession/Job Title

Membership Type (Check one): Annual $60.00      Millennium $250.00 (10 years)     Life $500.00 

Please mail Check or Money Order payable to:
TSU Dallas-Fort Worth Alumni Association
P.O. Box 131713
Dallas, TX 75313-1713

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