MEMBERSHIP APPLICATION (printable version)

GRAY PANTHERS OF METRO DETROIT
P.O. Box 341, Royal Oak, MI 48068
Information: 248-624-4753

Dues:Additional Contributions:

_______$25 individual membership_______Vic Shumacher Peace & Social Justice
Fund

_______$40 family membership      _______George & Alice Pollak Health Fund

_______$50 organizational membership_______Travel Fund


No person will be denied membership due to inability to pay.  Please make checks payable to Gray Panthers of Metro Detroit and mail to the above address.


 Name: ________________________________________________  Phone:  ________________________


 Address: _______________________________________________E-mail:  ________________________


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 of Metro Detroit
    Age and Youth in Action