Affiliate Membership Brochure Order Form - Right to Life of Michigan

"*" indicates required fields

Your Name*

E-mail*

Phone*

Please enter the following information as it is to appear on the brochure.

Affiliate name

Affiliate address

Affiliate phone

Affiliate e-mail

Affiliate website

Ink Options

Contact your printer to find what option will work best for your budget.

Full-color

2-color

Membership types and amounts (ex: gold $100, regular $25, student $10)

Please provide notes for any changes to the volunteer section