http://mssamn.com

MINNESOTA STREET SUPERINTENDENTS ASSOCIATION

2018 NON-MEMBER APPLICATION

Fee: 	$25.00 for each Non-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

Non-Member Applications (Each Member)	$25.00	
(Each additional Non-Member needs to complete a membership registration form)	
Total Number of Non-Members from your company/agency		
TOTAL AMOUNT ENCLOSED	$