Membership Form: Island Mountain Ramblers

Membership Registration Form

By joining today, your membership will expire December 31, 2024
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I understand that the Island Mountain Ramblers organize and manage events as a private members-only group through Meetup.com
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I acknowledge that I must have a Meetup.com account to view and register for club
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I confirm that my Meetup.com profile name does or will use my first name and last name as registered with the club on this form
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New MembershipRenewing membership
Membership Type:
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Single Membership$35.00CAD

Family Membership$60.00CAD

Associate (FMCBC)$16.00CAD

Student$21.00CAD

Total $0.00CAD
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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
Mailing 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 of Birth

MonthDayYear
Date
3rd Additional Applicant

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

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 imrmemberships@gmail.com
Club Retention of Vaccination Record*

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

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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
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Membership Registration Form

Family Members

Vaccination Status

Emergency Contact

Consent