Individual $ 35
Student/Senior $ 20
We regret that we are currently unable to receive dues payments by credit card.
Address ________________________________________ fax __________________________
Contact Person ___________________________________
Date: _____________________ Signed: _______________________________
Contact us at:
ICMJNOTICE: The International Coalition for Medical Justice, Inc., is a nonstock, not-for-profit Virginia corporation that has applied to the IRS as a charitable organization under Section 501(c)(3) of the Internal Revenue Code. A copy of our financial report is available from the Virginia Dept of Agriculture, Bureau of Consumer Affairs, or from our office.
763 Madison Rd.
Suite 206 1/2
Culpeper, VA 22701
Deane Collie, Executive Director
Back to Homepage