Prior testing application

From Nov. 1 through Dec. 31, we’ll review your scores from previously administered qualifying intelligence tests for free! Submit an application, your qualifying test scores and include the code FPE2014 to take advantage of this offer.

If you would like to take the Mensa Admissions Test, you do not need to complete and return this application. Instead, please request testing information in your area. You will receive communication containing additional details and contacts for testing in your area. A testing fee of $40 (U.S.) will be due to the proctor at the time of testing.


To submit evidence of prior testing, please complete this form, print and mail to the address listed below.


*First Name:
*Last Name:
*Address Line 1:
Address Line 2:
*City:
*State:
Zip(+4): -
*Home Phone:
Business Phone:
*Email:
Gender: Male Female
*Date of Birth: / /
 
Please send my evaluation results to the email address above.

Qualifying evidence review fee
$0.00 No qualifying evidence review fee in November and December!
I claim exemption from testing and enclose prior evidence of intelligence test scores in the top 2% of the general population. Prior evidence submitted must be a notarized copy or original documentation. All other evidence will NOT BE ACCEPTED. Please refer to our information on prior evidence. I understand that this is a non refundable evaluation fee.

Pay your dues at this time
$89.00 Additionally, I would like to pay my first year's dues ($89.00). My dues include fixed amounts for: my Mensa Bulletin subscription, my Local Group newsletter subscription, and Local Group support. If the prior evidence I submit is not acceptable, I understand that this amount will be refunded.

OR

$63.00 I am a family member of a dues-paid Mensa member who resides within the same Local Group boundaries and at the same mailing address as I do. I would like to pay my first year's dues ($63.00). Additional Mensan family memberships do not include subscriptions to the Mensa Bulletin or to Local Group newsletters. If the prior evidence I submit is not acceptable, I understand that this amount will be refunded.

OR

I would not like to pay my first year's dues at this time.

Payment Method: Credit Card
Check
Money Order
Card Type: Visa
MasterCard
American Express
Discover
Card Number: (no dashes or spaces)
Expiration Date: (mm/yy) /
Security Code: what's this?
 
Promotional Code: (if applicable)
 


Make your check or money order payable to American Mensa, Ltd. All payments must be drawn in U.S. funds. Please allow 2-4 weeks for processing of application. Print and mail this form to:

American Mensa, Ltd.
1229 Corporate Drive West
Arlington, TX 76006-6103

Phone: 817-607-0060
Fax: 817-649-5232