Name *

First Name

Last Name

Are you a Texins member? *

Yes

No

No, but I'd like more information on this

Building Name or Location *

NOTE: TI Family Memberships, Contractors, Co-locaters & Retirees should choose "TEXINS"

DMOS5

DMOS6

Kilby East

Kilby West

Research East

Research West

RFAB

SC Building

Sherman

South Building

South Campus - Forest Lane

TEXINS - TI Family Memberships, Contractors, Co-locaters & Retirees

Facilities

Please choose your form of payment. *

Payroll Deduction (REQUIRED for TI Employees and TI Family Members). By selecting this option you are authorizing Texins to proceed with a $40 for Texins members or $50 for non Texins members payroll deduction charge that will be submitted on January 27.

Credit Card (REQUIRED for Co-locaters, Contractors & Retirees). Please provide credit card payment at the front desk at Texins Fitness Center on or before January 27. If payment is not provided by the deadline you will not be able to participate in the Self Defense Workshop series.

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Select all that apply.

Aquatics

Fitness Programs

Group Fitness

Nutrition

Rec Leagues

Texins Events

Youth and Camp