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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.
   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. Member ID Number*
   If you do not know your member ID number please contact us at (909)944-4162 and a team member can assist you.
8. Last Name*
9. First Name*
10. Current Job Title*
12. Municipality or Government Unit*
14. Mailing Address*
16. City*
17. State/Province*
18. Zip/Postal Code
20. Country
22. Email Address*
23. Phone Number*
25. Remaining CMC Certification Fees
26. Payment
    -- Select One --Remaining CMC Balance - $75.00CMC Balance plus optional plaque fee of $40 - $115.00
27. Quantity
28. Shipping Cost
30. Taxable
32. Remaining MMC Certification Fees
33. 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
34. Quantity
35. Shipping Cost
37. Taxable
39. Optional Plaque (if not purchased above)
40. Payment
    -- Select One --CMC Plaque - $40.00MMC Plaque - $40.00
41. Quantity
42. Shipping Cost
44. Taxable
46. Replacement Certificate
47. Payment
    -- Select One --CMC Certificate - 5.00MMC Certificate - 5.00
48. Quantity
49. Shipping Cost
51. Taxable
53. Continuing Education Support (Optional)
54. Amount
    -- Select One --Foundation Contribution - $5.00Foundation Contribution - $10.00Foundation Contribution - $15.00Foundation Contribution - $20.00Foundation Contribution - $25.00
55. Quantity
56. Shipping Cost
58. Taxable
Leave This Blank:


59. Calculate Totals Proceed to Checkout

* indicates a required field