Southeast Michigan Mensa

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Testing Application

Name Birthdate
Address
City State ZIP
Daytime Phone Evening Phone
Email

Please check the appropriate box(es).

• Mensa Home Test (US$18)
• Mensa Admissions Test (US$40)
  • Second Saturday of the Month (Plymouth)
  • By Appointment (Select Location)
    • Ann Arbor
    • Downriver
    • Flint
    • Grosse Pointe
    • Plymouth
    • Sterling Heights
  • Non-verbal test (please also select a location)
• Culture-Fair Mensa Admissions Test (US$40)
  • Ann Arbor
  • Downriver
  • Flint
  • Grosse Pointe
  • Plymouth
  • Sterling Heights

Home Test fees should be payable to Southeast Michigan Mensa. Mensa Admissions Test fees should be payable to American Mensa, Ltd. If ordering both the Home Test and the Mensa Admissions Test, you will need to write two, separate checks.

Return this form and your check(s) to:
Pauline Averbach
2378 22nd Street
Wyandotte, MI 48192

Page last updated: Monday, September 1, 2008

Mensa does not hold any opinions or have, or express, any political or religious views.
Send mail to Webmaster Bryan Stanbridge with questions or comments about this Web site.

Copyright © 2008 Southeast Michigan Mensa.
The Mensa logo is a registered trademark of American Mensa, Ltd. and International Mensa Ltd..
All Rights Reserved.

Views and opinions expressed on this site, or any site linked to this one, are those of the individual writers/creators and are not endorsed by any official Mensa body. Mensa holds no opinions beyond its broadly stated constitutional aims. Mensa is not for profit and is not affiliated with any other organization.