Benefits of Manatee Membership :

• IMMS Membership Card
• Electronic newsletter
• 6 "Protect our Dolphins" wristbands
• Silver plaque
• IMMS Brick Paver (for a limited time)

First Name Last Name

Business Name

Street Address

Street Address (optional)

City State

Zip Code

Phone Email

Text as you wish it to appear on brick paver: (3 lines, 16 characters per line)

Brick Paver Line 1 Text

Brick Paver Line 2 Text

Brick Paver Line 3 Text

Name as you wish it to appear on silver plaque: (2 lines, 15 characters each)

(Picture may not be representative of actual plaque. Plaque will be similar.)

Donor Plaque Line 1 Text

Donor Plaque Line 2 Text

(Once the form is submitted you will be taken to Step 2 : Secure Payment Via PayPal)