Become a MVC Professional Member (2020)

BY COMPLETING THIS FORM, YOU ARE CONFIRMING MEMBERSHIP TO MICHIGAN FOR VACCINE CHOICE (MVC), A NON-PROFIT, MICHIGAN-BASED ORGANIZATION.

How did you hear about MVC?

Contact Information

Name

Address

This address will receive a confirmation email

Phone

Text Preference Text me when you have urgent news or action items. I understand that I can unsubscribe at any time.

Professional Contact Information

Name of Practice/Organization/Business

Same as above

Business Address

Would you like to list your business in a professional directory on the Michigan for Vaccine Choice website?

Yes, tell me more No thanks

Thank You Gift

We're offering 2020 Professional Members a complimentary vaccine choice promotional starter kit containing: reusable cotton bag, 8x11 poster, and an assortment of MVC materials such as business cards, brochures, and rack cards. Additional materials are available for purchase. Please contact communications@michiganvaccinechoie.org. Please let us know below if you would like to receive one of these starter kits for free as a thank you for joining or renewing in 2020.

Yes, please send me the promotional starter kit

2020 Membership Fee

Memberships are valid for the year in which they are purchased.

Please indicate a support level:

Payment Details

Credit/Debit Card Number

Expiration Date/CVC

Name on Card Card Billing Address

Become a MVC Professional Member (2020)

Description

Please Fix the Following