Tame: Texas Alliance For Minorities in Engineering

Fill out, print and fax or mail to TAME office: TAME, Inc., UT-Austin, R9200

10100 Burnet Road Bldg 16, Rm 10

Austin, TX 78758 PH: 512-471-6100 FAX: 471-6797

All required information must be provided.

For the Academic Year:

Cities/Towns served:

Does your alliance have a PO Box or other business address? yes no

If yes, Alliance Mailing Address :

City, State, Zip

Chair & Treasurer positions must be filled. Chair will serve as Alliance Representative on the TAME Board of Directors unless a person other than the Chair has been appointed by your alliance.

Alliance Chair & Representative to the TAME Board of Directors

Chair: Company:

Work #: Mobile #:

Home #: email:

Mailing Address:

Our alliance has appointed someone other than myself to act as the Alliance Representative on the TAME Board of Directors:

Board Representative (if other than Chair):

Company:

Work #: Mobile #:

Home #: email:

Mailing Address:

Alliance Treasurer

Treasurer: Company:

Work #: Mobile #:

Home #: email:

Mailing Address:

Alliance Co-Chair (if you have this officer, please fill in each box)

Co-Chair: Company:

Work #: Mobile #:

Home #: email:

Mailing Address:

Alliance Secretary (if you have this officer, please fill in each box)

Secretary: Company:

Work #: Mobile #:

Home #: email:

Mailing Address:

Alliance Program Coordinator (if you have this officer, please fill in each box)

Program Coordinator: Company:

Work #: Mobile #:

Home #: email:

Mailing Address:

Alliance Tracking Coordinator (if you have this officer, please fill in each box)

Tracking Coordinator: Company:

Work #: Mobile #:

Home #: email:

Mailing Address:

Other Alliance Officer (please specify title):

Name: Company:

Work #: Mobile #:

Home #: email:

Mailing Address:

Major Alliance Sponsors/Donors: