MEMBERSHIP APPLICATION (printable version)
GRAY PANTHERS OF METRO DETROIT
P.O. Box 37033, Oak Park, MI 48237
Information: 248-541-0230
Dues:
Additional Contributions:
Additional Contributions:_______$25 individual membership_______Vic Shumacher Peace & Social Justice
_______Vic Shumacher Peace & Social Justice Fund_______$40 family membership _______George & Alice Pollak Health Fund
_______George & Alice Pollak Health Fund_______$50 organizational membership_______Travel Fund
_______Travel FundNo 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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