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Fellow Member Online Application

Payment Instructions: Please note that the next screen will continue with payment by credit card via PayPal, keep your credit card ready before proceeding.

Fellow members will be able to take advantage of further benefits due to their seniority status. Those who are IIMP™ members for five consecutive years as regular members and are in good standing may qualify to apply to become an IIMP™ fellow member.
• Fellow Member Registration/Renewal Fee: $95.00 (U.S. Funds)


Confirm Current Information

Membership Number:
Surname:
Given Name:

Middle Name:

Home Phone:

Cell Phone:

Email:

Address:

City:

Postal/Zip Code:

Province/State:

Country:


Please check box, if this is your preferred mailing address.



Current Employment Information (If applicable)

Employer Name:

Your Job Title:

Website:

Work Phone:

Address:

City:

Postal/Zip Code:

Province/State:

Country:


Please check box, if this is your preferred mailing address.



Current Login Information

Login Name: 5-12 letters/numbers

Password: 5-12 letters/numbers




Payment Information

Membership Fee: (U.S. Funds)

Please note: the next screen will continue with credit card payment by PayPal.



Authorizations

Include your information in IIMP™’s online membership directory.
Email you information about IIMP™’s upcoming event and activities.
Permit third parties to contact you about promotional information.
Accept IIMP™'s Membership Agreement.


Comments/Questions (optional):



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