APIAvote-MI Membership Application
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First and Last
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Organization/Title
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Street Address *
Please include Apartment and Suite numbers
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City, State and Zip Code *
Please format as: City, MI 48234
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Email *
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Phone Number *
Please format as: (XXX) XXX-XXXX
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Fax
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Membership Type *
Note: Payment may be sent via mail or done online via PayPal. See details at the end of this form.
I can help with the following VOLUNTEER tasks; please contact me regarding:
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Congregation Affiliation:
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Fluent Language(s):
Please list all languages and dialects and indicate whether speaking, reading and/or writing.
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Special Talent(s):
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I have reliable transportation
Recruited by (if applicable):
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Date of application: *
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Payment Information:

Payment confirms membership for one year from January 2013 to December 2013.

Please mail this form and your payment to:

APIA Vote-Michigan
P.O. Box 44613
Detroit, MI 48244

APIA Vote–MI does not release membership lists to outside sources.

For information about Asian & Pacific Islander American Vote - Michigan, visit
www.apiavotemi.org or email us at: michigan@apiavote.org.

Every member counts.

Our Voice Counts!

Thank you for your support!

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