Minnesota Driver and Traffic Safety Education Association
MDTSEA     On Line Membership Form     MDTSEA
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What is your first name? *
What is your last name? *
What nickname do you use?
What title do you use? (ie. Doctor)
What is your address? *
What is your city, state and zip code? *
What is your e-mail address? *
What is your school or organization? *
What is your school district number?
What is your home phone number? *
What is your work phone number?
What is your cell phone number?
Are you teaching driver education? Yes No
Are you the school signer? Yes No
Who are you licensed by? Board of Teaching Department of Public Safety
            Both BoT and DPS No DE License
What Legislative district are you in?
What Congressional district are you in?
Regional workshops are held in the following towns. Which is closest?
Stillwater Marshall     Mankato     St. Cloud     Thief River Falls
Kasson (Rochester)     Willmar     Perham    Duluth    Shakopee
How do you want to pay your dues?
Mail a check to
MDTSEA, 38917 Timber Road, Avon, MN 56310
2021 dues = $0
I am a student at SCSU.
I will mail a check.
Please use the card below for payment.
Comment or Question:
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What is the expiration date?
What is the card's zip code?
What is the amount being paid?
Minnesota Driver and Traffic Safety Education Association
Last Revision: February 2021
Copyright © 2021
Created: February 2021
E-Mail to MDTSEA Webmaster
Secretary Janice Jensen-Skoviera
601 Richland Ave SW
Willmar MN 56201
Phone 320 231 0489
URL: http://www.mdtsea.net/memberform.html