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Education Payment Form

2. This form is to be used when making a final payment using Credit Cards only.
   
   IF YOU DO NOT SEE YOUR PAYMENT OPTION LISTED BELOW, PLEASE CALL KELLIE SIGGSON DIRECTLY AT (909)944-4162 TO DISCUSS YOUR OPTIONS
   
   If submitting payment by check please click here to download the form required for mailing a payment.
   <a href="https://www.iimc.com/DocumentCenter/View/62/Application-for-Admission-">Education Payment Form By Check</a>

   Education Payment Form By Check

4. This form does not replace the Application for Admission. Please use the Application for Admission when enrolling in either CMC or MMC Certification Program and submitting the required $50 non-refundable admission fee. Please contact Kellie Siggson, Education Associate at Kellie@iimc.com with any questions.

6. Last Name*

7. First Name*

8. Current Job Title*

10. Municipality or Government Unit*

12. Mailing Address*

14. City*

15. State/Province*

16. Zip/Postal Code

18. Country

20. Email Address*

21. Phone Number*

23. Remaining CMC Certification Fees

24. Payment
    -- Select One --Remaining CMC Balance - $75.00CMC Balance plus optional plaque fee of $40 - $115.00

25. Quantity

26. Shipping Cost

28. Taxable

30. Remaining MMC Certification Fees

31. Payment
    -- Select One --MMC Payment - $100.00MMC Payment $100.00 with optional plaque ($40) - $140.00MMC Payment - $300.00MMC Payment $300.00 with optional plaque ($40) - $340.00MMC Payment - $350.00MMC Payment $350.00 with optional plaque ($40) - $390.00

32. Quantity

33. Shipping Cost

35. Taxable

37. Optional Plaque (if not purchased above)

38. Payment
    -- Select One --CMC Plaque - $40.00MMC Plaque - $40.00

39. Quantity

40. Shipping Cost

42. Taxable

44. Continuing Education Support (Optional)

45. Amount
    -- Select One --Foundation Contribution - $5.00Foundation Contribution - $10.00Foundation Contribution - $15.00Foundation Contribution - $20.00Foundation Contribution - $25.00

46. Quantity

47. Shipping Cost

49. Taxable

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50. Calculate Totals Proceed to Checkout

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