Home NAMI Mid-Valley Membership Application

|  |

NAMI Mid-Valley

Membership Application

Name_______________________________

Address______________________________

City _____________________ Zip _________

E-mail________________________________

(for meeting and event notification only)

Annual Dues:

$35 Individual or Family

$50 Professional

$3 Open Door (low income)

$10 Local Newsletter only

Donation/memorial gift ______

(tax deductible)

Total ___________________

___Please contact me about volunteer opportunities

I'm interested in:

____Family to Family

____Support Groups

____Office Support

_____Community Outreach

____Newsletter

Return this form & your check to:

NAMI Mid-Valley

P.O. Box 1172

Corvallis, OR  97339-1172

|  |