Registration is $65 through 08/16/2008. On-site registration may not be available.

Download Registration Form

I. Primary Contact

This is the individual within the household who will receive all information, including follow-up correspondence. Individuals in different households or who wish to receive their own correspondence register separately.

Non-member registrants must be guests of Mensan registrants. We reserve the right to limit non-Mensan registrations.

First Name:
Last Name:
Address:
City:
State / Province:
Zip + 4:
Country:
Phone:
Email Address:


II. Registrants

Please list all registrants including primary contact. You will need membership numbers for those registered as Mensans. Proof of current membership will be checked.

1.   
First Name		   
Last Name
 
Badge Name

   Member
 Non-Member

Member Number


2.   
First Name		   
Last Name
 
Badge Name

   Member
 Non-Member

Member Number


3.   
First Name		   
Last Name
 
Badge Name

   Member
 Non-Member

Member Number