Government Membership Form

Government Annual Membership Levels

Your membership allows us to work on increased accessibility, efficient commerce, and enhanced safety on Minnesota Highway 23. Your involvement multiplies our effectiveness.

Select your preferred membership level for your organization type.

Donation Amount:

$ 3,000

I'd like to help cover the transaction fees of 0 for my donation.

Government Type

First Name

Last Name

Business / Organization Name

Email Address

Phone

Address

City

State (MN)

Zip Code

I agree

Who's joining today?

Personal Info

First Name *

Last Name *

Is this donation on behalf of a company?

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Yes

Company Name

Email Address *

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Select Payment Method

Donate with Mail In / Offline Donation
Donate with PayPal or Credit Card

To make an offline donation toward this cause, follow these steps:

Write a check payable to "Highway 23 Coalition"
On the memo line of the check, indicate that the donation is for "Highway 23 Coalition"
Mail your check to:

Highway 23 Coalition
222 20th Street SE
P.O. Box 1783
Willmar, MN 56201

Your donation is greatly appreciated!

Donation Total: $3,000