ICAN of Ann Arbor, Michigan

___ $30 Basic Subscriber
          U.S
___ $80 Professional Subscriber
___ $31 - $499 Supporter
___ $150 "Childbearing Years" Member (5 Years)
___ $300 "Childbearing Years" Member (10 Years)
___ $500 & up Lifetime
       Subscriber
___ $2000 Professional Lifetime Subscriber

Check or money order enclosed for
$__________________________

U.S. Funds Only!

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Address ____________________________________________________________

City________________________________ State _______ Zip+4 ______________

Phone ______________________________________________________________

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