Island Mountain Ramblers Membership Form

Membership Registration Form
Membership Type:
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Single Membership $ 35.00 CAD

Family Membership $ 60.00 CAD

Associate (FMCBC) $ 16.00 CAD

Student $ 21.00 CAD

Total $ 0.00 CAD
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FMCBC Parent Club:
As of 2019 the ACCVI is no longer a member of the FMCBC and does not qualify for the associate member rate.
School Name
Applicant's Name *

First Name Last Name

Address *

Applicant's Phone Number *

Area Code Phone Number
Applicant's E-mail *
Family Members

Family memberships allow for a maximum of four members. If your family has more than 4 members over the age of 10 years of age, please complete additional applications using "student" as the membership type.
1st *

First Name Middle Name Last Name
Email
example@example.com
Date of Birth

Month Day Year
Date
2nd

First Name Middle Name Last Name
Email
example@example.com
Date

Month Day Year
Date
3rd

First Name Middle Name Last Name
Email
example@example.com
Date

Month Day Year
Date
4th

First Name Middle Name Last Name
Email
example@example.com
Date

Month Day Year
Date
Emergency Contact
Contact Name *

First Name Last Name
Contact Number *

Area Code Phone Number
Consent
I understand that my name, membership status, and date I signed the waiver will be shared with club leaders. *

I undersand
Day of Registration *

Month Day Year
Today's Date
Should be Empty:

Membership Registration Form