I.I.M.A.A.
MEMBERSHIP/PROMOTIOIN APPLICATION FORM
LAST NAME*
FIRST NAME*
MIDDLE NAME
TITLE
COMPANY
MAILING
ADDRESS*
E-MAIL*
WEBSITE
HOME
PHONE
WORK*
PHONE
CELL
PHONE
FAX
DOB
GENDER
CITIZENSHIP
OCCUPATION
MARTIAL ARTS
STYLE/S
EXPERIENCE
RANK*
DATE OF PRESENT RANK
NAME & ADDRESS
OF SCHOOL OR ORGANIZATION
NAME AND RANK OF INSTRUCTOR
SPONSOR
APPLICATION FOR
PAYMENT METHOD
ADDITIONAL
INFORMATION
Send checks to:
I.I.M.A.A.
202 Sea Shores Drive
Port Saint Joe, FL 32456
