MEMBERSHIP APPLICATION FORM
NEWSLETTER SUBSCRIPTION FORM
HOME MEMBERSHIP
NEWSLETTER SEMINARS
RESOURCES EMAIL
ITM MEMBERSHIP/NEWSLETTER ~ P.O. BOX 12248, SANTA ROSA, CA 95406-2248
Please check the appropriate box that applies to you: { } NEW MEMBERSHIP { } RENEWAL
FIRST NAME _________________________LAST NAME _______________________________DATE________________
MAILING ADDRESS (STREET AND/OR P.O. BOX)_________________________________PHONE (___)_____________
CITY___________________________STATE_________________________ZIP____________FAX (___)________________
BUSINESS ADDRESS (IF DIFFERENT FROM ABOVE)______________________________BUS.# (___)______________
EMAIL ADDRESS______________________________________
PLEASE SEND MY MAIL TO { }BUSINESS { }HOME.
My annual dues accompany this form:
{ } $50 Regular Rate- seminar door fee $15
{ } $35 Student Rate- seminar door fee $15 (must be full time student with proof)
(Non-member seminar door fee is $20)
{ } $15 ($20 out of state) Newsletter Subscription only
{ } $175 White Card Membership (includes membership fee and seminars for one year- no door fee)