Name *

First Name

Last Name

Are you a Texins member? *

Yes

No

Building Name or Location *

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

DMOS5

DMOS6

Kilby East

Kilby West

LFAB

Maine

Research East

Research West

RFAB

SC Building

Sherman

South Building

South Campus - Forest Lane

Sugarland

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

Tucson

Participation in the Youth Swim Club is $50 per participant. Please indicate your form of payment below. *

Payroll Deduction (REQUIRED for TI Employees and TI Family Members). I would like to purchase the Youth Swim Club through payroll deduction. By selecting this option you are authorizing Texins to proceed with the $50 payroll deduction charge that will be submitted on or before the first session.

Credit Card (REQUIRED for Co-locaters, Contractors & Retirees). Please provide credit card payment at the front desk at Texins Fitness Center on or before the first session.

Would you like to be notified of any TEXINS Aquatics programs? *

Yes

No