APPLICATION FOR MEMBERSHIP

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Email *

Today's Date *

YYYY

Name *

Last & First

Other Names Used

List Last name first

Address *

Street, City, State, Zip Code

Phone number *

Date & Time of Birth *

YYYY

Time

Place of Birth *

Civil Status

Single

Married

Other:

Clear selection

Currently Employed?

Yes

Clear selection

Occupation

Name & Address of Employer

Formal Education

Please list all Formal Education: Degrees, Certificates or Papers and where obtained

Non-Formal Education

Please list all Non-Formal Education: Seminars and non-credit classes

Character References *

Please list three non-family references: Name, Address, Phone #, Relationship

In Case of an Emergency, Name two people who may be notified *

Name, Address, Phone #, Relationship

Why do you want to become a member of I.A.M.? *

How did you hear about I.A.M.? *

List all Organizations to which you are a member *

List your Interests or Hobbies *

Describe below your interest or involvement in the field of Metaphysics, self-development or mind expansion *

What are your Spiritual and/or Philosophical beliefs and Practices? *

What goals do you wish to achieve? *

For yourself or for I.A.M.

What talents or energies can you presently contribute? *

$20.00 Application Fee is enclosed? *

Paid Cash in-person

Mailed Check: International Association of Metaphysics, 5971 Broken Bow Lane, Port Orange, FL 32127

Paid via PayPal: https://www.paypal.com/paypalme/IAMdues Add a note section – located under the dollar amount you wish to send and indicate the payment you are sending.

Send me a copy of my responses.

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