Roads+ Contribution Form
Contributions are accepted year round by Roads+. Members in good standing have made a contribution of $50 or more in the current calendar year.
If you have questions, please contact Shelby Eva at: seva@micountyroads.org or 517.482.1189.
Name
*
Home Address
*
Home City, State and Zip
*
Email Address
*
Telephone Number
*
County of Residence
*
Employer
Required unless retired.
Occupation/Title
Required unless retired.
Employer Address
Required unless retired.
Employer City, State and Zip
Required unless retired.
Yes, I want to help elect legislators who support better roads and bridges for Michigan!
Roads+ Annual Membership requires a minimum contribution of $50.
Contribution amount (Please choose one)
*
Select option...
$50
$150
$250
Other
If you chose other above, please specify the amount you would like to contribute.
Payment Options (Please choose one)
*
Invoice (will be sent shortly after submission of this form)
Credit Card (Fill out form below)
Credit Card #
Expiration Date
CVV Code
Please select if you would like this card kept on file for automatic annual renewals.
*
Yes
No