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Membership
Please complete the form in its entirety. Step 1 of 2.
     

Benefits of Shark Membership :

  • IMMS Membership Card granting 10% off gift shop purchases
  • Online Newsletter
  • Family Name on Donor Plaque
  • Family Name on Brick Paver
  • 6 "Protect our Dolphins" wristbands
  • 1 IMMS Koozie
  • 1 "Dolphin Rescue" Car Magnet
  • 1 IMMS Tote Bag
  • 1 "Dolphin Rescue" Hat
   
First Name :  
Last Name :  
Business Name :  
Street Address :  
Street Address (optional) :  
City :  
State :  
Zip Code :  
Phone :  
Email :  
     
Name as you wish it to appear on Donor Plaque:(2 lines, 15 characters each)

(Picture may not be representative of actual plaque. Plaque will be similar.)
Donor Plaque Line 1 Text :  
Donor Plaque Line 2 Text :  
 
Text as you wish it to appear on brick paver: (3 lines, 16 characters per line)
Brick Paver Line 1 Text :  
Brick Paver Line 2 Text :  
Brick Paver Line 3 Text :  
(Once the form is submitted you will be taken to Step 2 : Secure Payment Via PayPal)
   
     
 
 
 
 
 
 
 
 
 
 
 
 
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