~~~ Los Angeles Area Mensa ~~~ West Los Angeles Mensa Exam Registration Form ~~~ (updated 09-25-09)

Raulette Woods, 310-571-6309 (Messages: No calls after 8 PM please) Contact: Raulette.Mensa-at-yahoo.com

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, please place that information in the Location section. I will send you a confirmation that you've registered for the upcoming Mensa exam. Those under the age of 18 are required to have a parent present, with photo ID, to fill out the testing authorization form.

LOCATION: UCLA Campus, Ackerman Union Building, Third Floor - Room 3517, 308 Westwood Plaza, Westwood, CA  90095 NOTE - Location may change, we'll let you know the actual location later on..

DIRECTIONS:  From 405: Take 405 (San Diego Freeway) to Wilshire Blvd. East, Travel east three blocks to Westwood Blvd. Turn Left on Westwood Blvd, Travel five blocks to Parking & Information Booth – Purchase Parking Voucher ($9) for Parking Structure 6 at Booth – continue on Westwood Blvd. (now Westwood Plaza) until it ends at… Parking Structure 6.

If you do not hear from me within a few days, please send me a separate email not using this form. Thanks! This form does not tell us, unless you fill it in, what testing session you wanted, so please be exact in the date and time information desired.