Print this page and fill out the information by hand. Mail to: 

Michelle Markusa

332 De La Seigneurie Blvd
Wpg, Mb
R3X 2C7

Special Area Group Membership Registration Form: MMYA  

Surname:_______________________________  First Name:___________________________

Address: (Number and Street or Box No.) 

 ______________________________________________

City/Town: _______________________________________    Postal Code:________________

Telephone: School/Business:________________________    Home:_____________________

Employer/School Div. No.:_________________________    Position:_____________________

Grade Level(s) Taught:________________  

  School:__________________________________

e-mail address: _______________________________________________

Membership Information

__ New    __ Renewal                                                           

MTS Member?                                                                 

__ Yes   __ No

Membership Type (Check One)

__ Full/regular     __ Student    __ Associate   

Amount sent (chq)  $____________ (enclose $20.00 full or $10.00 student)