Michigan Protection & Advocacy Service

Guestbook

If you are a new visitor, please sign our Guestbook and tell us a little about yourself! Please fill out the form below (ignore the Mail Code Identifier areas if you are signing our Guestbook for the first time).

If you have already signed our Guestbook, you can change or update the information you previously submitted by inserting the Mail Code Identifier which was assigned to you. This will retrieve your information from our database and allow you to make changes. If you are currently receiving subscription mailings from MPAS, the Mail Code information will appear on the mailing label.

If you subscribe to our newsletter enter the mailcode identifier on the mailing label to retrieve your current address profile:

Mail Code Identifier:

(** Denotes a required field.)

Title:

Mr.

Mrs.

Ms.

Other:

**First Name:

**Last Name:

Middle Initial:

Suffix:

III

Jr.

Sr.

Other:

**Street Address:

Extended Address:

**City:

**State:

**Zip Code:

County:

Phone:

Country:

Email Address:

Have you ever contacted Michigan Protection and Advocacy Service before? Yes No
Do you have a disability? Yes No	Or are you trying to help someone with a disability? Yes No
What is the disability? Are there any special needs or accommodations, in order for us to assist you, if so please explain:

Are you working with any other agency, firm or group? Yes No	Is anyone else helping you? Yes No
When is the best time to reach you, if we need to speak with you directly:

Subscription Request

Stay informed about MPAS activities by subscribing to one or more of the following publications or news sources. Update your description requirements by entering your Mail Code Identifier (found on your mailing label) and retrieve your current subscription profile. To cancel all subscriptions simply uncheck all of the boxes after retrieving your subscription profile.

HIV/AIDS		Exchange Newsletter
General Mail Announcements		MPAS Annual Report

Complaints and Comments

Whether you would like to voice a complaint or express a comment we want to hear from you.

Your Support is Appreciated

To find out about how you can support the ongoing work of MPAS in assisting people with disabilities.

Address Information

If you make changes to your Guestbook information, it will change the information maintained in the MPAS mailing database. If you are currently subscribing to MPAS mailings your subscriptions may be interrupted if the information you provide is incorrect. If you're entering new information for someone else, enter his or her Mail Code Identifier or delete the reference to your Mail Code, otherwise the changes made may be entered for your mailing information.

Privacy Statement

The personal information you enter at this web site will be held in strict confidence. For example, Ask the Advocate questions you submit may be used in the Frequently Asked Questions (FAQ) sections of this web site or in MPAS publications, but without any reference to the person submitting the question. Questions that are publicized will be altered to remove all personal references such as names, locations, or identifying detail.

MPAS is committed to maintaining the confidentiality of all clients contacting our agency. Please be aware any information you send via electronic communication, such as e-mail, is not guaranteed to be private due to the limits of current technology. If you have concerns about confidentiality or privacy, please contact our agency directly by regular mail or telephone/TTY at (517)487-1755 or toll-free in Michigan at (800) 288-5923.

If you sign our Guestbook or sign up to be on one of our mailing lists, please be aware this means mail or e-mail may be sent to you from our agency.

	Michigan Protection & Advocacy Service, Inc.
Lansing (517) 487-1755 \| TOLL FREE 1-800-288-5923 (Voice or TTY)
Fax (517) 487-0827 \| Email MPAS