MCIGS Membership Application

Please Select One: New Membership Renewal Membership

Please select a Membership type Individual membership ($25 USD) Institutional membership ($30 USD) Life membership ($250 USD) Charter membership ** ($10 USD)

Charter members must have been continuous members since 1981.

First Name Last Name Email Phone Number Address City Zip Code State Country I would like to receive the monthly newsletter through postal mail for an additional fee - USA Only ($10.00 USD)

MCIGS Scholarship Donation $5.00 Donation ($5.00 USD) $10 Donation ($10.00 USD) $20 Donation ($20.00 USD) $50 Donation ($50.00 USD) $100 Donation ($100.00 USD) I choose not to donate at this time.

Alternate (Snowbird) Address & Delivery Dates

If you selected a Family Membership, please include the names of the other eligible family members who reside at your address:

Names of Eligible Family Members Referred by

Please indicate below that you give permission to MCIGS to list your your name and location (ex: Betty Smith, City, State) as a new member in the Member Spotlight section of our newsletter. Email addresses and telephone numbers will NOT be published, made available to other members, or posted on our website.

Membership announcement Yes No

If you would like to make an additional donation to MCIGS, please visit www.mcigs.org/donate