Pay E-transfer Membership Form: Island Mountain Ramblers

Membership Registration Form

Memberships purchased today expire December 31, 2023
I understand that the Island Mountain Ramblers are moving event management to Meetup. I acknowledge that I need a Meetup account if I want to register for club events.*

I acknowledge that I need a Meetup account that uses the name on this form to join club trips.
Membership Type:

Single membership $35Family membership $60Associate (FMCBC)Student $21
*

New MembershipRenewing membership
FMCBC Parent Club:
As of 2019 the ACCVI is no longer a member of the FMCBC and does not qualify for the associate member rate.
School Name
Applicant's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Applicant's Phone Number*

Area CodePhone Number
Applicant's E-mail*
Renewing Applicant's E-mail*
example@example.com
Family Members

Family memberships allow for a maximum of four members. If your family has more than 4 members over the age of 10 years of age, please complete additional applications using "student" as the membership type.
1st Additional Applicant*

First NameMiddle NameLast Name
1st Additional Applicant Email
example@example.com
Date of Birth

MonthDayYear
Date
2nd Additional Applicant

First NameMiddle NameLast Name
2nd Additional Applicant Email
example@example.com
Date

MonthDayYear
Date
3rd Additional Applicant

First NameMiddle NameLast Name
3rd Additional Applicant Email
example@example.com
Date

MonthDayYear
Date
Vaccination Status

In order to enter the club's Meetup and join trips, you must provide proof of vaccination.
How will you submit your proof of vaccination or medical exemption?*

I am a club supporter and do not need access to MeetupI will attach my vaccine passport(s) to this formI will email my vaccine document(s) to imreventsmanager@gmail.com
Club Retention of Vaccination Record*

I authorize the club to retain a copy of my vaccination document(s) for club records only.
*

Browse Files

Cancelof
Emergency Contact
Emergency Contact Name*

First NameLast Name
Emergency Contact Number*

Area CodePhone Number
Consent
I understand that my name, membership status, and date I signed the liability waiver may be shared with club members.*

I undersand
Day of Registration*

MonthDayYear
Today's Date
Should be Empty:

Membership Registration Form

Family Members

Vaccination Status

Emergency Contact

Consent