Texas Electrical Safety Association

1512 W 34^th Street

Houston, TX 77018

Ph. 713-688-2000

Fax 713-957-0500

E-mail: 7136882000@t-e-s-a.org

Website: www.T-E-S-A.org

2008 MEMBERSHIP APPLICATION AND RENEWAL FORM

PLEASE PRINT ALL INFORMATION

DATE: ________________________________________________________________________________________________

 

NAME: _______________________________________________________________________________________________

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ADDRESS: ____________________________________________________________________________________________

EMPLOYER: ___________________________________________________________________________________________

EMPLOYER

ADDRESS: _____________________________________________________________________________________________

DAYTIME

PHONE#: ______________________________________________________________________________________________

 

EVENING

PHONE#: ______________________________________________________________________________________________

FAX#: _________________________________________________________________________________________________

 

MOBILE

PHONE#: ______________________________________________________________________________________________

 

E-MAIL: _______________________________________________________________________________________________
               (ESSENTIAL TO RECEIVE NEWSLETTERS - PLEASE PRINT VERY CLEARLY)
 

VOLUNTEER AREAS:  (Membership Drive, Fund Raising, Lobbying, Organizational Officer)

______________________________________________________________________________________________________

 

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SIGNATURE: ____________________________________

 

MEMBERSHIP FEE: $50 PER CALENDAR YEAR
 

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