Chapter Application

Please fill out the following form truthfully and to the best of your knowledge.
*You need a minimum of five (5) members to submit an application.

Once your application has been received, our board will review it and send you the next steps.

Subject

Name

First Name

Last Name

Phone

(###)

###

####

Email address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name of current organization (if applicable).

Please tell us why you want to start a chapter of IPM in your city/town?

How will you uphold the values of IPM?

Are you indigenous?

Yes

No

Other

What is your background in activism/grassroots initiatives?

Can you provide/consent to a Criminal Record Check?

Yes

No

With a minimum of five members required per chapter, please let us know how many you're planning on starting off with along with their names.

Chapter fees are either $20/month or $200/year. Please check off which method works best for your chapter.

Monthly

Yearly