Please mail Membership applications to
Jane Press
TCC State Secretary
PO. Box 23

Carmine, TX 78932-0023

Membership Application

Complete the form, print, and mail (with $30.00 annual dues) to:

Texas Cushman Club, Jane Press, PO Box 23, Carmine, TX 78932

☐ New Member ☐  Renewal  ☐ Veteran  ☐ Change of Information

Member Information:

Name: __________________________________________BirthDate____________________

Spouse Name:_______________________________________BirthDate_______

Address:­­­______________________________________________________________________

City:________________________________State: __________ Zip: ______________

Email:_________________________________________________________________

Telephone:___________________________________________________________

Recruited by:__________________________________________________________________