Please print this form and mail it with your contribution to:

Mackinac Center for Public Policy
140 W. Main Street
P.O. Box 568
Midland, MI 48640

NAME:

_______________________________

ADDRESS:

_______________________________

_______________________________

CITY:

_______________________________

STATE:

_______________________________

ZIP:

_______________________________

E-MAIL:

_______________________________

TELEPHONE:

_______________________________

AMOUNT:

___ $100.00 - $499.00 annual contribution - Mackinac Center Member

___ $500.00 - $999.00 annual contribution - Jefferson Society

___ $1,000.00 - $9,999.00 annual contribution - President's Council

___ $10,000 or higher annual contribution - 1851 Society

___ $10,000 or higher irrevocable pledge through estate planning - Legacy Society

___ Other: $___________

PAY BY:

___ Credit Card ___ Check (enclosed)