IMSA Online Forms - Membership Questions???
1-800-723-IMSA
 
* in front of the items below denotes fields that are required.
Application Type
*(please choose one) Membership Application Membership Renewal Sustaining Membership Membership Update
 
Information
Prefix: Mr. Ms. Mrs. NONE
*First Name: M.I.
*Last Name: Suffix: (Jr., Sr., III, etc.)
Informal: Job Title:
*Organization Name: Department:
*EMail Address:  or check box if you Do Not Have an EMail Address
*Are you a member of IMSA? Yes No
Work Information
*Work Address:
*City: *State/Prov:
*Zip/Postal: *Country:
*Work Phone: Work Fax:
Toll Free #:
Home Information
Home Address:
City: State/Prov:
Zip/Postal: Country:
Home Phone: Optional Cell Phone: Optional
Preferred Contact
*Preferred Billing Address: (please choose one) Work Home
*Preferred Mailing Address: (please choose one) Work Home
From time to time IMSA and the IMSA sections may contact you by email regarding issues and activities that may be of interest to you.
If you do not wish to receive emails from IMSA and your IMSA section, please check box.
 
Areas of Interest - Check all that apply
Public Safety Telecommunications
FCC Licensing and Frequency Coordination
Interior Fire Alarm Systems
Land Mobile Radio
Public Reporting Systems
Roadway Lighting
Signs and Pavement Marking
Traffic Signal Inspection
Traffic Signal Systems
Wireless Data
Work Zone Temporary Traffic Safety
 
Membership Class
Class Description Annual Dues
*(please choose one) please fill in any applicable information below for the Class chosen.

(In US Funds)
ACTIVE Employee or official of a Government agency or employee of a private contractor actively involved with public safety systems or operations.

$85.00
PUBLIC AGENCY Any Governmental body or agency with three (3) or more personnel who qualify for active membership. All personnel must be affiliated with a single agency or body.

$75.00
Per Member
ASSOCIATE Individuals not eligible for active membership or those associated with commercial or non-profit organizations who have knowledge, experience or interest in public safety.

$85.00
STUDENT Full-time students of an accredited college or university enrolled in a field related to IMSA Activities.
Name of School:
Projected Date of Graduation:

$35.00
*(please choose one) please fill in any applicable information below for the Class chosen.

(In US Funds)
SUSTAINING DESIRING TO cooperate with IMSA and to work closely with its members throughout the World and being in sympathy with the objectives of the organization, we hereby make application for a SUSTAINING MEMBERSHIP in this association.

The following persons:
  1. First Name: Last Name:
  2. First Name: Last Name:
  3. First Name: Last Name:
  4. First Name: Last Name:
will be our four official representatives in all matters relating to the association which are open to your Sustaining Members, but it is understood that our officers, engineers, representatives, or others of our organization can attend and participate in all meetings of your various Sections and Annual Meeting.

If by mail, we are attaching herewith our check for $400.00, covering one year's dues as a Sustaining Member, in accordance with the provisions of your Constitution, or you can bill us for this amount upon the signing and mailing or by the act of electronically transmitting of this application and its acceptance by the membership committee of the association.

$400.00
UPDATE This option is for Current Members updating the contact information only.

$0.00
 
Method of Payment
*(please choose one) Credit Card Check Purchase Order
Credit Card information will be gathered when you complete the Secure Payment Gateway on Step 3
Check Number:
Purchase Order Number:
 
Form Submission
Recommended By: (if applicable)
Comments: