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MEMBERSHIP APPLICATION - NAMI Prince George's County

I would like to support(join/renew membership) NAMI Prince George's County as:

 _______ General Member ..................................................  $        35.00
   
 _______ Open Door Member .............................................  $          3.00
   
 _______ Donor with tax-deductible contribution ..................

 $ ______.00

                                                                           TOTAL AMOUNT  $ _____.00
Membership benefits include subscription to NAMI newsletters, membership at the
national level - National Alliance  on Mentally Illness(NAMI), the state level - NAMI MD
and locally - NAMI Prince George's County.

NAME:    

Title _______ FirstName _______________ MI ___ LastName _________________

MAILING ADDRESS:

House Number ______________________________________________________

City _________________________ State _____ ZipCode __________  - ________

PHONE:    _______-_______-______________________

E:MAIL:    _____________________________________


Please print this page, fill in and mail, with check or money order(payable to NAMI Prince George's County), to:
                                        
                                                   N A M I Prince George's County
                                               Attention: Membership Committee
                                                           Post Office Box 959
                                                    Greenbelt, MD 20768-0959
 

To join NAMI on-line, click here - http:/www.nami.org/join


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