Home Membership Membership Form

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NAMI FDL MEMBERSHIP FORM (To print and fill out)

Membership is good for one year. I wish to join or renew (please check one):

            ___      $35.00 Individual or Family Dues

            ___        $3.00 Open Door Dues

                                      For families or individuals with limited incomes.

Date:  _________________                                     

Name:  _______________________________________________________

Address:  _____________________________________________________

City, State and Zip:  _____________________________________________

Telephone:  _______________  E-Mail:  ______________________________

I wish to make a cash donation to NAMI FDL:

            ____  $25    ____  $100      $________(Other)  Donation (tax deductible)

            $_______  Donation “In Memory of”: ___________________________

            $_______  Donation "In Honor of": _____________________________

TOTAL ENCLOSED:          $_______________  Membership / Donation

Make checks payable to “NAMI FDL”. Bring to our next Thurs. meeting or mail to:

                                              NAMI Forsyth Dawson Lumpkin

                                              P.O. Box 2665

                                              Cumming, GA 30028

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