IMMS Staff

Membership

Please complete the form in its entirety. Step 1 of 2.


Benefits of Sea Lion (Family) Membership : •IMMS Membership Card •Electronic newsletter •4 "Protect our Dolphins" wristbands •Bronze 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 bronze 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)