Please indicate the type of testing desired. ____ Mensa Home Test (USD $18).
____ Mensa Admissions Test (USD $40). Please indicate test to be taken:.
MENSA ADMISSION TEST APPLICATION First Name _______________________ Last Name _______________________ Address __________________________________________________________ __________________________________________________________ City
_______________________ State ___________ ZIP ______
Phone ________________________ Best time to call __________________ Email ________________________ Birthdate ________________________ (mm/dd/yyyy)
Please indicate the type of testing desired. ____ Mensa Home Test (USD $18) ____ Mensa Admissions Test (USD $40). Please indicate test to be taken: ____ Standard Test
____ CultureFair (a nonverbal test)
Please indicate location of testing desired. ____ Ann Arbor
____ Flint
____ Sterling Heights
____ Downriver
____ Plymouth
____ West Bloomfield
Home Test fees should be payable to Southeast Michigan Mensa. Mensa Admissions Test fees should be payable to American Mensa, Ltd. NOTE: If ordering both the Home Test and the Mensa Admissions Test, you will need to write two separate checks. Mail this form and payment to: SEMM Testing, Pauline Averbach, 2378 22nd Street, Wyandotte, MI 48192