Circle of Friends Membership

 

ONE TIME PAYMENT

 

MIM is a registered 501(c)3 nonprofit organization.

Please complete the form below and click "Submit" to confirm your membership.

To submit this form, all "*" fields must be filled in.

 

Duo $100
Family $150
Song $250
Rhythm $500
MEMBER INFORMATION
Primary First Name*
Primary Last Name*
Other First Name
Other Last Name
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Phone*
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PAYMENT INFORMATION
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ADDITIONAL INFORMATION
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