Your Membership Helps to Support:

• Patient packet of information
• Transportation to a Physician/Medical Facility
• Support Meetings
• ID bracelet and card
• MG Prescription Medication
• Literature on MG issues and concerns
• Agency Operations

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MGA Membership

Membership Options

Select An Option$50 Annual Membership$100 Contributing Membership$250 Circle of Friends$500 Benefactor Membership

Other/Additional Amount

Choose from the following

MG PatientRelativeFriend

Namefull name

Address

City/State/Zip

Phonexxx-xxx-xxxx

Emaila valid email

Payment options: Mastercard, Visa, Discover, American Express and PayPal. A PAYPAL ACCOUNT IS NOT NECESSARY TO PAY. Look under the PayPal members login for a link to pay with a Credit Card. All payments are made through PayPal's secure payment portal.

Items	Qty	Total
Membership	1	[field2]
Membership/Other	1	[field15]

Make Payment

Please don't hesitate to call our office if you have any questions and/or issues with the online registration form. 

Phone: (248) 591-4419

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Donations are tax deductible to the extent provided by law. Thank you for your support! MGA is a 501 ©3 Agency.