I want to support the Michigan Alliance Campaign to preserve and strengthen Social Security,

Medicare and an affordable Rx drug program for all.

Low Income___$10                                             Individual___$25 

Organizations less than 50 members___$50            Organizations of 50 to 100 members___$75 

Organizations over 100 members ___$100            Other Contribution_______________

Make checks payable to: MASSSM,  Mail to: Robert Sisler, Chair, 748 Ashland, Detroit, MI 48215

Name (please  print)______________________________________________________________

Address________________________________City___________________________Zip_______

Phone: Day____________________Eve__________________Email________________________

Organization___________________________________________   _         Amount: __________

I am interested in helping MASSSM grow.  I can:

Help with the web site______                                                Serve on a commitee_________

Help with fund raising ______                                               Help with Mailings______

Data base entry ______                                                         Make phone calls _____

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