ADTSEA Membership Information & Application

If you are not a member of                             Name __________________________________________________

ADTSEA or if you need to renew

Your membership (Check mailing                Address _____________________________________Apt. _______

Label for expiration date.),

Please complete the application

Below and mail directly to                              City________________________ State________ Zip ____________

ADTSEA.

                                                                                Phone (H)  (      )________________ (W) (      )__________________

$50 Professional Membership

        (1-year membership)                        Fax (       )____________________________

Make check payable to ADTSEA.                              Email Address____________________________________________

Mail to:                                                                  $50 Professional Membership:  _______Renewal ________New

Highway Traffic Safety Center                      

R&P Building                                                      Signature _____________________________________________________

Indiana University of Pennsylvania       

Indiana, PA  15705-1092                                          Date ___________________________

ADTSEA Membership Information & Application

If you are not a member of                             Name __________________________________________________

ADTSEA or if you need to renew

Your membership (Check mailing                Address _____________________________________Apt. _______

Label for expiration date.),

Please complete the application

Below and mail directly to                              City________________________ State________ Zip ____________

ADTSEA.

                                                                                Phone (H)  (      )________________ (W) (      )__________________

$50 Professional Membership

        (1-year membership)                        Fax (       )____________________________

Make check payable to ADTSEA.                              Email Address____________________________________________

Mail to:                                                                  $50 Professional Membership:  _______Renewal ________New

Highway Traffic Safety Center                      

R&P Building                                                      Signature _____________________________________________________

Indiana University of Pennsylvania       

Indiana, PA  15705-1092                                          Date ___________________________