MEMBERSHIP FORM

 ____ Yes, I want to help. Count on me as a member of Flint Area
      Right to Life.

 ____ I am a new member; ____ I am affirming my membership

        ____ $15.00 Individual      ____ $5.00 Student
        ____ $8.00 Senior           ____ Other $________________
        ____ $25.00 Family

Name:___________________________________________________________

Address:________________________________________________________

City: ________________________; State: _________; Zip: _________

Phone No.______________________;  E-mail:_______________________

I am available to help with:

_____ Phone calls  ____ Special events ____ Fund-raising
_____ Speaking     ____ Letter writing ____ Mailings
_____ Office Work  ____ Friend to Friend Cards
____ Church Representative______________________________________
                              (Specify church)

As a member, you will receive the Flint Area Right to life
Newsletter, and you are invited to use the educational materials
at our office. (Your contributions and gifts to Flint Area Right
to Life are not tax deductible).

Please make your check payable to "Flint Area Right to Life".
Print and Mail this form along with your donation to:

                    Flint Area Right to Life
                G-4482 N. Genesee Road - Unit C
                     Flint, Michigan 48506
                     Phone: (810) 250-0218
                   Email: FlintRTL@att.net