MiCivics Membership Form A and B

Champion Civic Education

MiCivics Membership Information!
Contact Information

Please indicate the primary contact below to discuss professional learning.
Name

Prefix First Name Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Title
Organization/Building/Affiliation
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Payment Options

Please use section above to generate invoice/purchase order as needed.
I would like to pay by:

Check (Michigan Center for Civic Education; Attn: Membership; 306 Townsend; Lansing, MI 48933) Square Pay (credit card) Other

My Products

MiCivics Level A Membership 2020-2021 Entry fees waved for: 1 We the People Class Entry (Additional classes $250) 1 Mock Trial Team Entry (Additional teams $275) 1 Class Project Citizen Portfolio Entry 3 Hours of Dedicated MCCE Support (1 Hour Virtual, 1 Hour Planning and 1 Hour Follow Up/Reflection) Window Cling Sticker Certificate of Civic Champion Status Signature Logo ADDITIONAL MEMBERSHIPS MAY BE PURCHASED FOR MORE PROFESSIONAL LEARNING

$ 500.00 Quantity Thoughts on possible professional develop include:

MiCivics Level B Membership 3 Hours of Dedicated MCCE Support (1 Hour Virtual, 1 Hour Planning and 1 Hour Follow Up/Reflection) ADDITIONAL MEMBERSHIPS MAY BE PURCHASED FOR MORE PROFESSIONAL LEARNING Window Cling Sticker Certificate of Civic Champion Status Signature Logo

$ 250.00 Quantity Thoughts on possible professional develop include:

Total

$ 0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

My signature authorizes my school/building/district/class to be a champion of civic education. As such, I adhere to all partner agreements with the Michigan Center for Civic Education.

Clear
Date

Month Day Year
Date
Thank you! We are excited to work with you.
Should be Empty:

Champion Civic Education

Contact Information

Payment Options

Thank you! We are excited to work with you.