IIMM Membership Application

IIMM Membership Application

Institute membership is open to any person resident in Ireland who is qualified as, or in training to become a bridge watch-keeping officer.
Date of Application*

DayMonthYear
Date
Type of Application being requested*

Full Membership (€50.00 Annually)Associate Membership (€35.00 Annually)Retired Membership (€25.00 Annually)Cadet Membership (€10.00 Annually)
Name*

First NameLast Name
Nationality*
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Country CodeArea CodePhone Number
Email*

Confirmation Emailexample@example.com
Grade & No. of Certificate if applicable
Where certificate was issued
If you hold a certificate of competency please attach a copy here

Browse Files

Cancelof
Proposer
If not known please leave blank
Seconder
If not known please leave blank
GDPR*

I consent to the IIMM holding my data and adding my email address to a mailing list for the purpose of communication regarding the institute.
Please verify that you are human*
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