Membership Form

 

 

 

 

 

 

PERSONAL MEMBERSHIPS:                    GROUP MEMBERSHIPS:

$15 Basic Grassroots                                                  $60 Nonprofit
$20 Individual                                                                $100 Business  
$60 Family
$100 Supporting
$500 Sponsor
$1000 Sustainer

Please specify:

        Donation             Membership           Both                                                       $                  Enclosed

Name                                                                                                                          Date                                       

Organization                                                                                                                                                            

Address                                                                                                                                                                   

City                                                                                                                   State               Zip                           

Phone                                                                        E-mail                                                                                    

SEND YOUR CONTRIBUTION OR MEMBERSHIP DUES TO:

MCRP/Rural Action
P.O. Box 129
New Straitsville, OH 43766

Questions? Call 740.394.2047

Comments are closed.