WV Medicaid Recipients' Union : Membership

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MEMBERSHIP

If you are a Medicaid recipient, or the parent/legal guardian of a Medicaid recipient, please JOIN US! Just print, complete, and send this form to via U.S.Mail* to:

Medicaid Recipients' Union - WV
PO Box 1273
Dellslow WV 26531

*The inclusion of a self-addressed, stamped envelope would be appreciated.

Or, cut and paste the form below into an e-mail, complete, and send to: join@MRUWV.org

NAME(S)
MAILING ADDRESS
MAILING ADDRESS
PHONE(S)
E-MAIL
I am a: Medicaid recipient; Parent and/or legal guardian of a Medicaid recipient; Neither of the above, but I support MRUWV's mission. Number of Medicaid recipients in your household: _________
SIGNATURE
DATE

While not required for membership, we request that each member make an annual contribution. The recommended contribution amount is $20, although you are welcome to donate more if you have the means (or less if you do not). If you are unable to contribute financially (and even if you are), we'd be happy to have a contribution of your time & energy!

Amazon Honor System

The West Virginia Medicaid Recipients' Union relies on volunteers to support its advocacy efforts. Thus, donations in any amount are gratefully accepted both electronically via credit card (left) and via U.S.Mail to cover the costs of postage, copying, bumper stickers, ads, operating expenses, etc. Checks or money orders should be made payable to "MRU WV." Thank you!

~*~ Contributions are NOT (yet) tax deductible. ~*~

++ PRIVACY STATEMENT ++

MRU WV will never share its members' personally-identifiable information (name, address, phone, or e-mail address) with any outside person or organization without express consent.

This page last updated Friday 17 June 2005