Pay E-transfer Membership Form: Island Mountain Ramblers

Membership Registration Form

Memberships purchased today expire December 31, 2025
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 $38Family membership $65Associate (FMCBC) $16Student $22
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
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

Consent