Membership Registration Form
New memberships and renewals are valid for one year and expire at the end of the month in which payment is made.
NAME: _______________________________ ADDRESS: ________________
CITY: _____________________ STATE: _____________ ZIPCODE: ___________
PHONE: _________________________ EMAIL: ______________________________
Choose your membership category
___ Individual $35 ____ *Family $35 ___ ***Consumer/Open Door $3
**Corporate: ___ Bronze $100 ___ Silver $500 ___ Gold $750 ___ Platinum $1000
___Sustaining $5000 ____ Renewal ____ New
*Family Membership includes all family members but only has 1 vote. If each family member wants a vote each one must join.
** The Bronze, Silver, Gold and Platinum Corporate memberships are annual and the Sustaining is lifetime.
*** Consumer/Open Door is for Consumers with limited income.
Cut Here ________________________________________________________________________________
Make checks payable to NAMI Collin County. Print this form, fill it out, and mail with your check to
NAMI CCO Membership Committee
Post Office Box 867264
Plano , Texas 75086-7264