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Membership Form
YES, I would like to join the Universal Health Care Action Network of Ohio.
$50 Basic Individual Membership $75 Intermediate Membership $100 Patron Membership $ sliding scale (an amount you can afford) $100 Basic Organization Membership $250 Patron Organization $ Additional Contribution TOTAL ENCLOSED $ All members receive a subscription to "E-Update, " our bi-weekly electronic newsletter. Please make checks payable to "UHCAN Ohio." UHCAN Ohio is a non-profit 501(c)(3) organization. All contributions are tax deductible.
$50 Basic Individual Membership $75 Intermediate Membership $100 Patron Membership $ sliding scale (an amount you can afford) $100 Basic Organization Membership $250 Patron Organization $ Additional Contribution
TOTAL ENCLOSED $
All members receive a subscription to "E-Update, " our bi-weekly electronic newsletter.
Please make checks payable to "UHCAN Ohio." UHCAN Ohio is a non-profit 501(c)(3) organization. All contributions are tax deductible.
Home Phone:
Work Phone:
and mail with your check to:
Universal Health Care Action Network of Ohio 404 S. 3rd St. Columbus,OH 43215-5413
or
and pay by credit card through Paypal.
2800 Euclid Avenue, Suite520 Cleveland, OH 44115-2418 Tel: 216-241-8422 or 800-634-4442 FAX: 216-241-8423 Email: cleveland@uhcanohio.org
404 S. 3rd Street Columbus, OH 43215-5413 Tel: 614-456-0060 FAX: 614-456-0059 Email: columbus@uhcanohio.org
