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IMGCA Offline Membership Application

  This is the form for applying for IMGCA membership by mail, with payment by check. If you prefer to pay online using your credit card or PayPal account, go to our Online Membership Application Form.

Please print this page or copy it into your word processor, fill it out and mail it to IMGCA, 39116 Fremont Hub #1303, Fremont, CA 94538 United States . Please include your check payable to IMGCA.

A star to the left of an item indicates a required entry.

  Name ______________________________________

  Choose a membership type (prices listed are for annual membership):
Professional ($40)___ Student ($10)___
Volunteer ($40)___ Parent ($20)___
Institutional ($100)___ Affiliate ($60)___

  Membership Length:

  One year___   Two years___   Three years___

  Male___   Female___
    Date of birth __________________________________

  Work address _________________________________

  Work phone __________________________________

  Email address ________________________________
    Alternate email address ________________________
    Home address ________________________________
    Home phone _________________________________
    Academic status ______________________________
    Occupation __________________________________
    Research interests:

    Do you want to be included in the IMGCA member directory on the web site?  Yes___   No___

    Check this box to agree to terms and conditions I have read and agree to the terms and conditions of IMGCA membership and to the terms and conditions of using the IMGCA web site.

Privacy notice:
The information submitted on this application is used only for IMGCA purposes. At no time will we share any of this information with any other person or company.

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The International Mental Game Coaching Association
39116 Fremont Hub #1303
Fremont, CA 94538 United States
Phone: 408-705-8877

Office Hours: Monday-Friday, 10am-6pm PST. Closed weekends and holidays.
Private backrooms in the IMGCA membership and certification areas are open 24-7, 365 days a year.

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