Texas Register Liaison Form

TEXAS REGISTER LIAISON FORM

Please delete the following Texas Register liaison(s):

Texas Register Agency Code: _____

Agency Name: ____________________________________________________

Name: ____________________________________________________

Please add the following Texas Register liaison(s):

Texas Register Agency Code: _____

Agency Name: ____________________________________________________

Name: __________________________________________________________

Title: ____________________________________________________________

Phone Number: ___________________________________________________

Fax Number: _____________________________________________________

E-mail Address: ___________________________________________________

Name: __________________________________________________________

Title: ____________________________________________________________

Phone Number: ___________________________________________________

Fax Number: _____________________________________________________

E-mail Address: ___________________________________________________

*Please fax the information to the Texas Register at (512) 463-5569*