http://mssamn.com

MINNESOTA STREET SUPERINTENDENTS ASSOCIATION

2018 NEW/RENEWAL APPLICATION
GENERAL MEMBERSHIP

Fee: 	$100.00 for the first General Member Application
$50.00 for each additional General 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

General Application (First Member)	$100.00	
Additional General Applications (Each Member)	$50.00	
(Each additional General Member needs to complete a membership registration form)	
Total Number of General Members from your agency		
TOTAL AMOUNT ENCLOSED	$