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Michigan Association of Senior Centers
Name of Organization:___________________________________________________________________ Director's Name:___________________________________________Title:_________________________ Address:______________________________________________________________________________ City:_______________________________________State:___________Zip:_______________________ Phone:______________________________________Fax:______________________________________ Email:______________________________________Cell:______________________________________ Organization's website address (URL): http://___________________________________________ Note: As a benefit to MASC members, website address and link will be posted on the MASC website www.MIseniorcenters.org Other Members: (List all others in your center that would be members/with email addresses) ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ (Please indicate type of membership by Circling One)
Make all checks payable to: Michigan Association of Senior Centers (MASC) If you have any questions concerning this invoice, contact Sue Koivula: 248-349-4140.
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