Change of Address 
Form

Thank you for updating our database.  Please be sure 
to update the database for the national IMA as well.  
This form is for the local chapter only.
Name  
Company Name  
Title  
Work Phone   Ext.    
Fax Number    
Home Phone    
Email Address  
 
Home Address:    
Address1  
Address2  
City  
State/Province  
Zip/Postal Code  

Business Address:    
Address1  
Address2  
City  
State/Province  
 Zip/Postal Code  
Mail IMA information to    Business    Home


   The following questions are optional:
Do you attend  
IMA Meetings?  		   Yes  No
Do you attend 
CPE Classes?		   Yes   No
Do you prefer Lunch or Dinner meetings?     Lunch   Dinner