MnIAAA Membership Registration
NIAAA Member # (if known, if not enter UNKNOWN) *
First Name *
Last Name *
Date of Birth *
Gender *
School E-Mail *
Region *
Administrative Region
Yrs of Service *
School Name *
School Address *
School City *
School State *
School Zip Code *
Payment Method *
The annual MnIAAA Membership fee is $130.00 if payment is by check. If you choose the credit card option, fees are added, your cost will be $135.00. Send check payable to: MnIAAA c/o Mike Beck, 780 Acorn Circle, Monticello, MN 55362. If you would like an invoice or a receipt, please e-mail Mike Beck at
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