( ) Update directory information Date: __________________

( ) Renewal of Membership (January to December) ( ) Check here if you WANT

( ) New Member your name included in the

Membership Directory

Please type or print:

( ) Mr. ( ) Ms. ( ) Mrs. ( ) Miss

Last Name:__________________________ First Name(s):________________________

Address:________________________________________________________________

City:___________________________________ State:________ Zip: ______________

Residence telephone:__________________ Office telephone: _____________________

Email address: ___________________________________________________________

Texas Hometown: _______________________ University: _______________________

Membership Dues are $20.00 per individual and $30 per family per calendar year.

Amount paid: $ _________________ Signature: ________________________________

Please enclose your check and this completed form and mail to:

Texas State Society

P. O. Box 1368
Bowie, Md. 20718-1368