NAMI Southwest
Invites you to become a member
Donations are tax
deductible to the extent allow by law. Membership dues assist with the NAMI Advocate,
NAMI Illinois' Stateline, and the NAMI Southwest newsletters for
one year. Membership dues are good for one year.
 | Choose the type of membership: The following membership fees include
dues to NAMI National, NAMI Illinois and your local affiliate. |
€ Consumer $ 1.00
€ Individual $35.00
€ Family
$40.00
€ Agency
$45.00
| What is your relationship to mental illness? (Optional) |
€ Self
€ Child
€ Parent
€ Friend
€ Sibling
€ Professional
€ Spouse
€ Other
| Contact Information *
Indicates required field |
*Name
Title
Agency
*Address
*City
*County
*State
*Zip
Email
Phone ( )
Fax ( )
I have enclosed an additional donation of $
to help support NAMI Southwest. I understand that this donation
is tax deductible to the extent allowed by law.
Please print out this form at home and mail with your payment to:
NAMI Southwest
PO Box 23
Oak Lawn, Illinois 60454-0023
Please make your check payable to NAMI Southwest. Your name will be
forwarded to the National and State organizations.
