http://mssamn.com

MINNESOTA STREET SUPERINTENDENTS ASSOCIATION

2018 NEW/RENEWAL APPLICATION
ASSOCIATE MEMBERSHIP

Fee: 	$250.00 for the first Associate Member Application
$75.00 for each additional Associate Member Application 
       	(Includes meeting lunch fee)
NAME		
ADDRESS		
CITY		STATE		ZIP		
PHONE		FAX		
CELL PHONE		
E-mail                  		
(please print clearly)	PLEASE INCLUDE TO ENSURE RECEIPT OF ELECTRONIC ANNOUNCEMENTS IN A TIMELY MANNER	
EMPLOYER		
YOUR POSITION		

Return with check made payable to “MSSA” to:	

Tim Kieffer, MSSA
7800 Golden Valley Road
Golden Valley, MN  55427

Associate Application (First Member)	$250.00	
Additional Associate Applications (Each Member)	$75.00	
(Each additional Associate Member needs to complete a membership registration form)	
Total Number of Associate Members from your company		
TOTAL AMOUNT ENCLOSED	$