Circle of Friends Membership

 

RECURRING 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 $8.30 monthly   or $25 quarterly
Family $150 $12.50 monthly   or $37.50 quarterly
Song $250 $21 monthly   or $62.50 quarterly
Rhythm $500 $42 monthly   or $125 quarterly

 

Recurring Amount*
Frequency*

MEMBER INFORMATION
Primary First Name*
Primary Last Name*
Other First Name
Other Last Name
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Address*
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Zip*
Phone*
Email*
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PAYMENT INFORMATION
Payment Info
ADDITIONAL INFORMATION
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