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IMMAA Individual Membership Form
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Name
*
First
Last
Postal Address
*
Address Line 1
Address Line 2
City
State / Province / Region
Postal Code
Postal Address is required for your official IMMAA ID Card to be sent to you.
Phone
*
Email
*
Club
*
Name of IMMAA registered Club
Date of Birth
*
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MM
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Photo Upload
*
Click or drag a file to this area to upload.
Please upload a picture to be used on your IMMAA ID Card. Use a passport style image. A selfie from your your phone will suffice.
IMMAA Individual Membership
*
Price:
30,00 €
12 Month Membership to IMMAA for one individual.
GDPR Agreement
*
I consent to having this website store my submitted information so they can respond to my inquiry.
Total
0,00 €
Credit Card Info
*
Card
Name on Card
Submit
