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Name: __________________________________
Address: ________________________________
City, State, Zip: _________________________
Phone: _________________________________
E-mail: _________________________________
The following information is required by law and is not used for any other
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Please print and mail form with check or money order to:
Humane Voters of Michigan
P.O. Box 70163
Lansing, MI 48908
Note: Since Humane Voters of Michigan is organized as a political action committee,
donations are not tax deductible.