MiCASSA SUPPORTER The list of MiCASSA Supporters keeps growing! But we need your group’s support too! Sign up today:
MiCASSA Support _____ Please list our organization as a MiCASSA Supporter. _____ We would like to work on the state level to support MiCASSA. _____ We can provide in-kind resources to support MiCASSA. _____ We can provide financial support for MiCASSA. _____ Please add us to the MiCASSA mailing list for updates. Name of Organization: _______________________________ Contact Person: __________________________________ Address: ___________________ City: ____________ State: _________ Zip: __________ Phone: ( ) ____________ Fax: ( ) _____________ TDD ( ) ____________ e-mail: _______________ Our group is a national ________ / state ________ / local ________Send to:
Date: ______________ ********************************* dbs_____ list_____ pkg____