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TRI-COPC SUPPORT/MEMBERSHIP FORM

NAME: ________________________________________________________________________

ADDRESS: _____________________________________________________________________

                   _____________________________________________________________________

EMAIL:  _______________________________________________________________________

TELEPHONE:  ___________________________________________________________________

(    ) MEMBERSHIP:   $10.00.  I would like to become a member of TRI-COPC for this calendar year.

Optional:   I would like to make an additional contribution of $ _________ .                     

(    ) SUPPORT:  I do not wish to become a member, but I would like to support                                    

TRI-COPC by contributing the following amount: $____________  .                             

Please make your check/money order payable to "TRI-COPC, Inc." and mail to:

TRI-COPC, Inc.
Annie Goetz, President
10419 S Mackinac Trail
Dafter, MI 49724

THANK YOU!

Contribution is not tax-deductible.

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