Infant Massage USA CEIM Membership $75.00

Infant Massage USA Membership Application.
To download and Fax Application - Click Here
To Call in your application, call Toll Free 1-888-635-4786, Mon-Fri 9AM - 4PM Central Time

First name: Last name:

Home Phone: Alternate Phone:

Street Address:

City: State: Zip:

Email*: (*Please provide, if possible, as this will be a primary method for communication.)

Membership Status (Please select one):

Certified Educator Date of Certification:

Associate Member* (not a student or educator):
Please explain interest in joining Infant Massage USA (parent, child development organization, etc.)

Marketing/Publicity
Special Events Fund Raising
Newsletter
Membership
Regional Group Development
Other (please specify):

Website Listing
Please designate how you want your contact information listed on the website:

Name:

E-mail:

Phone:
*listing your phone number is a new feature and is optional

To opt-out of the CEIM directory on the IMUSA website, please initial here: 

(type name for signature)
My signature above confirms that I have read and have a copy of the IMUSA membership agreement.  Payment of Membership fee of $75.00 must be made and confirmed for application
to be accepted.