Michigan Citizens for Water Conservation
P.O. Box 1, Mecosta, MI 49332

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Name:   
Residence Address: date:

City:
State:   Zip:

Alternate Address:    date:

City:
State:   Zip:
Residence Telephone (including area code):  
E -mail Address: Alternate E-mail:

I’m particularly interested in working on the following committees:

Fund Raising/Financial Membership
Public Relations/News Media Legal
Legislation (political) Education/ Grassroots- Petitions
On-going Research Communications/ Web site
Other skills or contacts that may be helpful to this group:

Yes! I want to help support MCWC protect our Lakes, streams and groundwater in Michigan, by joining        and  becoming a member of MCWC.

    $25 Individual

  $10 Student/Retired

  $40 Family

  $250 Lifetime Individual Member $250

  $500 Lifetime Family Member $500

  $_______ Other

  Please online, or mail to Michigan Citizens for Water Conservation, PO Box 1, Mecosta, MI 49332.

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Last updated January 19, 2006