Membership Form Membership Type: Membership Type: Corporate Membership Individual Membership Basic User Name Surname Title DOB Day: DOB Month: DOB Year: ID Card No: Mobile Number: Address Line 1: Address Line 2: City CityAttardBahar ic-CaghaqBahrijaBalzanBidnijaBirguma/San Pawl Tat-TargaBirkirkaraBirzebbugaBlata l-BajdaBugibbaBulebel Industrial EstateBurmarradBuskettCospicua (Bormla)DingliDwejraFguraFlorianaFontana (Gozo)Fort CambridgeFort CambridgeGhajnsielem (Gozo)Ghajn TuffiehaGhammar (Gozo)Gharb (Gozo)GharghurGhasri (Gozo)GhaxaqGnejnaGudjaGwardamangiaGziraHal FarHamrunHandaqHigh RidgeIbraggIklinKalkaraKapparaKercem (Gozo)KirkopKortinKuncizzjoniLandrijietLijaLuqaMadlienaMaghtabManikataMarsaMarsalforn (Gozo)MarsascalaMarsaxlokkMdinaMelliehaMgarrMgarr (Gozo)MistraMostaMqabbaMriehelMsidaMtahlebMtarfaMunxar (Gozo)Nadur (Gozo)NaxxarPacevillePaolaPembrokePendergardensPietaPortomasoQala (Gozo)QawraQormiQrendiRabatSafiSalinaSan GwannSan Lawrenz (Gozo)Sannat (Gozo)Santa Marija EstateSavoy GardensSelmunSenglea (Isla)SiggiewiSliemaSta. VeneraSt. JuliansSt. Pauls BaySta. LucijaSta. Lucija (Gozo)SwatarSwieqiTa XbiexTa' Monita ResidenceTarxienTas-SellumTigne PointVallettaVictoria (Gozo)VittoriosaVittoriosa Waterfront (Birgu)WardijaXaghra (Gozo)XemxijaXewkija (Gozo)Xlendi (Gozo)XghajraZabbarZebbieghZebbugZebbug (Gozo)ZejtunZurrieq Postcode: Email Address I, hereby confirm that the information given on this form is true I, hereby confirm that the information given on this form is true I, hereby confirm that the information given on this form is true I, agree to abide by MIM Terms & Conditions I, agree to abide by MIM Terms & Conditions I , agree to abide by MIM Terms & Conditions Number 14 + 13 = Submit