TEXPERS Membership

Retirement System Application

Membership is subject to approval by TEXPERS Board of Directors

System Name:
	Mailing Address
Address:
City/State/Zip:
	Physical Address Same as mailing address
Address:
City/State/Zip:
	Contact Information
Phone number:		Fax number:
Email:
First name:		Last name:
Title:
	Administration Please enter the market value of the system's assets as of September 30th to calculate your membership dues:
Total Market Value Of The System's Assets:
Total Annual Membership Dues Payable: Formula: $ * .000005 - Minimum $1/Maximum $5000			$0
Administrator first name:
Administrator last name: