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-more at NAMI.org-
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NAMI-CT, Inc.
241 Main Street, 5th Floor
Hartford, CT 06106

Yes I would like to be a part of NAMI Newington.

Name _______________________________________________

Address______________________________________________


City_________________________________________________


State________________    Zip Code______________________

Phone______________________________________________


EMAIL_______________________________________________

I would like to join at this level:

...Individual,Family Membership_________ $35.00 
      
Family members,friends,supporters of and those living with mental illness

.... Open-Door Membership_____________  $3.00
      
For those with limited financial means

..... Professional Supporter_____________ $60.00      
Includes annual membership for one individual

..... Agency Champion_________________ $125.00      
Includes annual membership for one individual

I would like to make an additional contribution of $________________toward the work of NAMI-CT.

In honor of _________________________________________________________  

 or

In memory of _______________________________________________________


We are a private, nonprofit organization.


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