MichiganDems.com: Join/Renew Membership

Join / Renew Membership

Contributions are not tax deductible for federal income tax purposes.

Your contribution could be used in connection with federal elections and is subject to the limitations and prohibitions of the Federal Election Camgaign Act. Paid for by the Michigan Democratic Central Committee/Michigan Democratic Central Committee Federal Account, 606 Townsend, Lansing, MI 48933, 517-371-5410, and not authorized by any federal candidate or candidate's committee. Federal law requires us to use our best efforts to collect and report the name, mailing address, occupation and employer of indiviudals whose contributions exceed $200 in a calendar year.

YOUR MEMBERSHIP IS VALID FOR ONE (1) YEAR FROM THE DATE WE CHARGE YOUR ACCOUNT
unless 2 year membership is checked. All memberships are for an individual (except Couples Membership)

	Trustee - $2,500
	President's Club - $1,000
	Eleanor Roosevelt Club - $300
	Century Club - $125

	Neil Staebler Club - $78
	Couples - $60
	Supporter - $40
	Basic - $20

	Retiree - $10
	Student - $10

I am enclosing dues for a two (2) year membership

Please charge my credit card:		Full Amount		Quarterly*		Monthly*
*Quarterly and Monthly billing available for Neil Staebler and above memberships only

Member Information
* Legal First Name :
( * for Couples membership) Spouse Name :
* Legal Last Name :
* Credit Card Billing Address :
* City/State/Zip :
Residence Phone :
* E-Mail :
Occupation :
Name of Employer :
Employer Address :
City/State/Zip :
Business Phone :
Fax :
Home Address : (* if different from billing address)
City/State/Zip :
* Required

Paid for with regulated funds by the Michigan Democratic State Central Committee, 606 Townsend St., Lansing, MI 48933.
Not authorized by any candidate or candidate�s committee.