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IMB BIVALVES - ACADEMY CHALLENGE FORM
Your Name
(Required)
First
Last
SCC#
(Required)
Email
(Required)
Your Region
(Required)
Region 1
Region 2
Region 3
Region 4
Region 5
Region 6
Region 7
Region 8
Region 9
Region 10
Region 11
Region 12
Region 13
Region 14
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Region 16
Region 17
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Region 19
Region 20
Your Chapter
(Required)
You do not need to enter all your certificates at once, you may enter just the ones you have completed and return to this form to enter the remaining certificates later.
IMB 101 - Bivalves, Part 1 (Grade)
Please select your grade
100% - Distinction
90% - 99% - Honors
70% - 89% - Pass
IMB 101 Date Completed
MM slash DD slash YYYY
Upload a copy of your IMB 101 Certificate (optional)
Accepted file types: pdf, jpg, Max. file size: 2 MB.
IMB 102 - Bivalves, Part 2 (Grade)
Please select your grade
100% - Distinction
90% - 99% - Honors
70% - 89% - Pass
IMB 102 Date Completed
MM slash DD slash YYYY
Upload a copy of your IMB 102 Certificate (optional)
Accepted file types: pdf, jpg, Max. file size: 2 MB.
IMB 103 - Bivalves, Part 3 (Grade)
Please select your grade
100% - Distinction
90% - 99% - Honors
70% - 89% - Pass
IMB 103 Date Completed
MM slash DD slash YYYY
Upload a copy of your IMB 103 Certificate (optional)
Accepted file types: pdf, jpg, Max. file size: 2 MB.
IMB 104 - Bivalves, Part 4 (Grade)
Please select your grade
100% - Distinction
90% - 99% - Honors
70% - 89% - Pass
IMB 104 Date Completed
MM slash DD slash YYYY
Upload a copy of your IMB 104 Certificate (optional)
Accepted file types: pdf, jpg, Max. file size: 2 MB.
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