| Fax
or mail a copy of this membership form to the SEMCC offices:
Southeast
Michigan Census Council, Inc. If you have questions
or need further assistance regarding membership, call 248-354-6520 or
email: |
SEMCC Membership Form PRIMARY REPRESENTATIVE FOR ORGANIZATION Name _________________________________________________________ Title___________________________________________________________ Organization____________________________________________________ Address________________________________________________________ City, State, Zip___________________________________________________ Phone__________________________ Fax____________________________ Email__________________________________________________________ ADDITIONAL REPRESENTATIVE Name _________________________________________________________ Title___________________________________________________________ Phone__________________________ Fax____________________________ Email__________________________________________________________ ADDITIONAL REPRESENTATIVE Name _________________________________________________________ Title___________________________________________________________ Phone__________________________ Fax___________________________ Email__________________________________________________________ FEE SUMMARY Sustaining Membership___________________________________________ Organizational/Primary Rep._____________ @$90 ____________________ Additional Reps________________________ @$60 ___________________ TOTAL DUE $__________________________________________________ Payment Enclosed: Payable to SEMCC ____________________________ Please Bill P.O.#_______________________________________________ |