Minnesota Alliance of Black School Educators

MABSE 2011-2013 Membership Application

Name: _____________________________________________

Address: ___________________________________________

___________________________________________________

Home Phone: ________________________________________

Work Phone: _________________________________________

School/Agency: _______________________________________

___ Teacher___ Counselor___ Principal___ Administrator

Social Worker____ Other____________________________

Committee Choice_________________________________

2008-2010 dues=40.00

Please make check payable to MABSE

MABSE

P O Box 582245 MINNEAPOLIS, MN 55458

PHONE: (612) 588-5809

WEBSITE: www.angelfire.com/ma2/mabse2.index.html

EMAIL: mabse2001@yahoo.com