Arizona Driver and Safety Education Association

Membership Registration

Complete this form and mail it with your $15* annual membership fee to:

Jeanne Seely

ADSEA Treasurer

P.O. Box 32694

Tucson, AZ 85751

*Membership period is from March 1 through February 28 each year. Those joining before February 28, 2006 will be considered active through February 28^th of 2007.

PLEASE PRINT

NAME ____________________________________

Home Address ____________________________________

City/ State/Zip ____________________________________

School/Affiliation ____________________________________

Address ____________________________________

City/State/ZIP ____________________________________

Email Address #1 ____________________________________

Email Address #2 ____________________________________

Best Phone Number for contact (_____) ______________________

Preferred Contact method? (Please circle at least one)

HOME SCHOOL Email #1 Email #2 Phone

PLEASE NOTE: All future conference information should be accessed through www.ADSEA.org unless otherwise specified through Home or School postal. Subject line on email notices will be “ADSEA NEWS” or “Driver Education Spring (or) Fall Conference Information”.