Membership Application
Please Print and Mail this Application to the Address Below
Note (* indicates required information)
Prefix: Mr. Mrs. Ms. Dr. Rev. Rabbi Imam Sr.
* Name:
* Congregation or Institution:
* Address1:
* Address2:
* City:
* State:
* Zip: -
* Phone: (No punctuation)
Fax: (No punctuation)
Email:
Tax Exempt ID:
* Type of Membership: Full Member ($100.00)
Affiliated Member ($75.00)
Individual Member ($50.00)
Student, Senior, Low Income ($25.00)
Make checks payable to:
Michigan Interfaith Power & Light (MiIPL)
