National Alliance on Mental Illness
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NAMI Lane County
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NAMI of Lane County membership application
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Print this page or download document below (see "Related Files"). Please fill it out and send to:
NAMI Lane County
76 Centennial Loop, Suite A
Eugene OR 97401
Annual membership gives you:
- Our local, informative monthly newsletter
- State and national membership newsletters
- An effective advocacy on vital issues
- Representation on local and state boards
Please mark an 'X' on the appropriate line
- ___ Voting member ($35/yr)
A relative/guardian of mentally ill persons or those persons themselves.
- ___ NAMI of Lane County newsletter only ($15)
Available only to members of an NAMI group outside of Lane County
- ___ Low Income Membership ($3)
- ___ Sponsors ($100)
1 year Company/Association membership
- ___ General Donation
- ___ NAMI of Lane County Foundation
- ___ Gift in memory of______________.
- ___ Do not want gift recognized publicly
Name ______________________________________
Address ___________________________________
City, State, Zip___________________________
Phone number ______________________________
NAMI of Lane County, Inc.
76 Centennial Loop, Suite A
Eugene OR 97401
Phone:(541)343-7688
Email: office@namilane.org
A United Way Agency
Page updated February 16, 2012.
by Larry Cummings
Related Files
Membership Form (PDF File)
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