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Name ______________________________________ |
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Choose a membership type (prices
listed are for annual membership):
 Professional
($100)___ |
Student
($50)___ |
| Volunteer
($100)___ |
Parent
($50)___ |
| Institutional
($200)___ |
Affiliate
($200)___ |
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Membership Length: |
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One
year___ Two years___ Three
years___ |
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Male___ Female___ |
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Date of birth __________________________________ |
* |
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Work address _________________________________ |
* |
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Work phone __________________________________ |
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Email address ________________________________ |
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Alternate email address ________________________ |
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Home address ________________________________ |
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Home phone _________________________________
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Academic status ______________________________ |
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Occupation __________________________________ |
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Research interests:
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Do you want to be included in the IMGCA
member directory on the web site? Yes___ No___
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I have read and agree to the terms
and conditions of IMGCA membership and to the terms
and conditions of using the IMGCA web site. |
Please
print this page or copy it into your word processor, fill it
out and Contact IMGCA for mailing instructions. Please include your check payable to IMGCA.
