NALIP

IMA Membership Application

Contact Information
First Name *
Last Name *
Synod *

Address 1 *
Address 2
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Office Phone
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Optional Information
Interim Training Level	No Training Discernment Basic Course Advanced Course

Roster	Associate in Ministry Clergy Diaconal Ministry Deaconess

Present Position

Task Forces I would be willing to serve (Check all that apply):	Membership Advocacy (with synods and congregations) Communications (newsletter and website) Other (list area of interest):

IMA Dues
2012 Membership *Special Rate* - Dues for 2011 & 2012 IMA combined - $90 (usually $120) 2012 Membership - $60 2012 Synodical Membership - $100 Life Memberships Life Membership: Up to 55 years — $600 Life Membership: Ages 56–60 — $420 Life Membership: Age 61 + — $300

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2012 Conference

June 14-16, 2012
(Immediately following the IMN Conference)

Hyatt Regency Buffalo Hotel
Two Fountain Plaza
Buffalo, NY 14202
Conference Information
Additional Information
Conference Presenter
Online Registration Form