Form Center

2. PLEASE NOTE WE NO LONGER PROVIDE THE OPTION TO PURCHASE PLAQUES THROUGH IIMC.

   If you have already paid for a plaque, and not been refunded, contact Marlena Hernandez at marlena@iimc.com . 

   This form is to be used when making final payment using Credit Cards only. 

   IF YOU DO NOT SEE YOUR PAYMENT OPTION LISTED BELOW, PLEASE EMAIL MARLENA HERNANDEZ AT MARLENA@IIMC.COM TO DUSCUSS YOUR OPTIONS. 

   If submitting payment by check please click here to download the form required for mailing a payment. 

   For your convenience, we have included a link where you can order one like it on Amazon, Walnut Grove Slide-in Certificate Plaque and Document Holder 

   
   

   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 or EPP Programand submitting the required $50 non-refundable admission fee.
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. I am paying for:
27. Remaining CMC Balance
28. Price
29. Quantity
30. Shipping Cost
32. Taxable
36. Remaining MMC Certification Balance:
37. Price
38. Quantity
39. Shipping Cost
41. Taxable
43. Replacement Certificate
44. Payment
    -- Select One --CMC Certificate - 5.00MMC Certificate - 5.00
45. Quantity
46. Shipping Cost
48. Taxable
50. Replacement Pins

    You will automatically receive a pin with your CMC or MMC designation. 

    This is for those who received their initial pin with certification and would like another or to replace a lost pin.

52. Name
    CMC Replacement Pin
53. Price
54. Quantity
55. Shipping Cost
57. Taxable
59. Name
    MMC Replacement Pin
60. Price
61. Quantity
62. Shipping Cost
64. Taxable
66. IIMC Foundation Education Contribution
67. Amount
    -- Select One --Foundation Contribution - $5.00Foundation Contribution - $10.00Foundation Contribution - $15.00Foundation Contribution - $20.00Foundation Contribution - $25.00
68. Quantity
69. Shipping Cost
71. Taxable
Leave This Blank:


73. Calculate Totals Proceed to Checkout

* indicates a required field