~ Los Angeles Area Mensa ~ PASADENA Area Mensa Exam Registration Form ~~~ (updated 09-30-07)

Dave Felt, Mensa Proctor, PO Box 515, Sierra Madre, CA 91025 626-355-8315 (No calls after 8 PM please) Mail to: feltdd at verizon.net

Please fill it out as accurately as possible, then press the SEND button to email the information to me. (This information should be the same as where you'd like your test results sent.) If you need testing in a different area (Lancaster, Bakersfield etc,) please place that information in the Comments section. I will send you a confirmation that you've registered for the upcoming Mensa exam.

If you need the Culture-Free exam (given several times a year) please REQUEST that in the Comments section, with the proper Date and Time. Otherwise we assume you are registering for the standard English-based exam.

If you do not hear from me within a few days, please send me a separate email not using this form. Thanks!

PLEASE do not press the ENTER or SEND key until finished - use the TAB key or the mouse cursor to move from field to field, and when finished, press the SEND BUTTON to send this information to us. Thanks!