Cook Inlet Mountaineers
Membership Application
Type of Membership:
___ Single Individual
___ Family Membership
Mailing Address: _______________________________________________________________________
City: ______________________________________________ State: ______ Zip: __________________
Home Phone (______) __________________________ Cell: (______) ____________________________
Email: ________________________________________________________________________________
Name(s) and Age(s):
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
___ Membership dues for CIM Organization $10 Individual ~ $15 Family $____________
___ Donation (help with website hosting costs + events) $____________
Total Amount Paid $____________
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
Primary Member Name:(print)
_____________________________________________________________________________________
Signature:
_____________________________________________________________________________________
