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:

(See the PDF or Printer Friendly version for the address to which you may send this application and your contribution)

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______                                                Help with Mailings ______

Help with fund raising ______                                               Registration at programs ______

Data base entry ______                                                         Make phone calls _____

Serve on a committee_______

Suggestions for programs/fund-raising:                               

Contribute.pdf

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