Making It Right Here.

Contributors Application

Contact Person:

Company Name:

Mailing Address:

City, State, Zip:

Phone Number:

Email:

Contribution Amount $

Contribution CategoryContribution Amount
Level I - Platinum$20,000 or more
Level II - Gold$5000 to $19,999
Level III - Silver$2,000 to $4,999
Level IV - Bronze$200 to $2,000
Level V - Steel$1 to $199

Print and mail this completed application with your check (no cash) payable to "NIMA" to:

NIMA
1626 Sixth Avenue, North
Lewiston, Idaho 83501

This is your invoice. Upon receipt of your payment NIMA will send you a receipt for your records. Please mail your application and dues today!

1626 6th Avenue North | Lewiston Idaho 83501 | 208-746-0015

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http://www.northima.org/