Minnesota Driver and Traffic Safety Education Association
High School Driver Education - The Key To Safer Drivers
Membership Application

Name: First _______________ Last _________________________

School/Organization _________________________ ISD # _____

Home Address __________________________________

    City _____________ State ____ Zip Code _______

Work Address _____________________________ [ ] Retired

    City _____________ State ____ Zip Code_______________

Send MDTSEA materials to [ ] Home or [ ] Work address.

Phone (H) (___) ___ ____ (W) (___) ___ ____ (C) (___) ___ ____

E-mail address ______________________________________

Are you currently getting MDTSEA emails? . . . . . . . . . . . . . . . . . . . . . . . . . . . . [Yes] [No]
    (If not, does your school address block group e-mails?)
Are you currently teaching DE? . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . [Yes] [No]
License type . . . . . . . . . . . . . . [Board of Teaching] [Dept. of Public Safety] [Both] [None]
Are you currently the signer for your school? . . . . . . . . . . . . . . . . . . . . . . . . . . . [Yes] [No]
Are you an American DTSEA member? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . [Yes] [No]
Which new legislative district do you live in? . . . . . . . . . . . . . . . . . _____ Work in? _____
Which congressional district do you live in? . . . . . . . . . . . . . . . . . . _____ Work in? _____
Regional workshops are held in the following towns. Which is closest?
. . . . . . . . . . . . . . . Stillwater [ ] Marshall [ ] Mankato [ ] St. Cloud [ ] Thief River Falls [ ]
. . . . . . . . . . . . . . . . .Kasson (Rochester) [ ] Willmar [ ] Perham [ ] Duluth [ ] Shakopee [ ]
Membership type . . . . . . . . . . . . . . . . New [ ] Renewal [ ] Sustaining [ ] SCSU Student [ ]
Dues = $40.00     Membership year is Jan. 1 - Dec. 31
Make checks payable to MDTSEA and send this application to:     Joe Christensen           E-mail MDTSEA@Cloudnet.com
    38917 Timber Road
    Avon, MN 56310         Phone: 320 746 2619
Minnesota Driver and Traffic Safety Education Association
Last Revision: February 2018
Copyright © 2013
Created: January 1998
E-Mail to MDTSEA Webmaster
Secretary John Palmer
832 Halliday Road
St. Cloud, MN 56301
Phone: 320-252-8786
URL: http://www.mdtsea.net/membership.html