Retired Faculty and Staff Association
Membership Form

RFSA Member Form

Retiree Last Name
First Name
Middle Initials

Salutation

Spouse's Full Name

Are you the spouse of a deceased Texas State retiree?
Yes No

Texas State Department or Office
Year Employed
Year Retired

Address
City
State
Zip

Email Address
Telephone
() -

May we publish your email address
on our web site? Yes No

What kinds of activities might interest you? (Check all that apply)

Monthly or quarterly luncheons Bridge

Annual social event Investments

Lectures or programs Books

Travel (In-State or Out-of-State) Discussions

Tours of University facilities Exercise

Audits of University courses Health

Other activities? Give us your ideas.

How should the University better serve or communicate with retirees?

Other comments.
Please use this area to make any suggestions which you think would be helpful
in creating a viable retiree organization at Texas State.

If you do NOT want a copy of the completed form sent to the email address you provided above, uncheck this box.

Clicking the button above will submit this membership form to:

Retired Faculty and Staff Association
c/o Division of University Advancement
960 J.C. Kellam Building
Texas State University-San Marcos
San Marcos, Texas 78666
www.txstate.edu/rfsa/

Retiree Last Name	First Name	Middle Initials	Salutation
Spouse's Full Name	Are you the spouse of a deceased Texas State retiree? Yes No
Texas State Department or Office		Year Employed	Year Retired
Address	City	State	Zip
Email Address	Telephone () -
May we publish your email address on our web site? Yes No

Monthly or quarterly luncheons	Bridge
Annual social event	Investments
Lectures or programs	Books
Travel (In-State or Out-of-State)	Discussions
Tours of University facilities	Exercise
Audits of University courses	Health

Retired Faculty and Staff AssociationMembership Form

What kinds of activities might interest you? (Check all that apply)

Retired Faculty and Staff Association
Membership Form