Main Street Medina




Support MSM > Join Main Street Medina > Printable Membership Form

Main Street Medina Membership

_____ $40 individual/family/senior/student
 
_____ $200 MSM Supporter                                  

_____ $500 MSM Partner

_____ $1000 MSM Champion

_____ Additional contribution (100% tax deductible)
$_____Total enclosed                              
 
Name:______________________________________________________

Address:____________________________________________________

City, State, Zip:_______________________________________________
 
Business Name (if applicable)___________________________________

Email:______________________________________________________

Phone:_____________________________________________________ 

Method of payment 

____ Bill me   
____ Check (payable to Main Street Medina)
____ Visa
____ MasterCard
 
Please call the Main Street Medina Office for credit card transactions
 
Please completely fill out the form and send with payment to:

Main Street Medina
23 Public Square, Suite 220
Medina, OH 44256

 

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