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





*City                                                                       *County                                           

*State                  *Zip                                         


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.