CORRESPONDENT’S MEMBERSHIP APPLICATION FORM

  • Correspondent membership in IMIA is available to individuals who reside in countries that do not have an appropriate organization eligible for National Membership in IMIA.
  • Membership is subject to approval by the Board of IMIA and subsequent confirmation by IMIA’s General Assembly.
  • Correspondents will be invited to attend meetings of the General Assembly of IMIA, but will have no voting rights.
  • Correspondents may freely participate in IMIA activities.
  • There is no fee for Correspondent Membership.

Country

Name:_________________________________________________________

Primary Title:_________________________________________________________

Second Title:_________________________________________________________

Organization:_________________________________________________________

Address:_________________________________________________________

_________________________________________________________

__________________________________________________________

Tel: _____________________________ Fax: _______________________________

E-mail Address: __________________________________

Reason for application:

Please attach an electronic photo of yourself.

Please return to:

Steven A. Huesing
Executive Director, IMIA

Tel: +1.780.489.4531
Fax: +1.780.489.3290

imia@shaw.ca

5782 — 172 Street Edmonton, AB CANADA T6M 1B4