Membership

Please enroll me as a member of NAMI Jackson County. I understand that my dues enlists my membership in all 3 levels of NAMI (national, state, and local). I also understand that I will receive quarterly newsletters and reduced conference rates from NAMI national and NAMI Illinois.

Print the form below, complete the information, and forward it along with the proper payment to the address at the bottom.

Individual family membership	$30
Consumer membership	$3
Professional membership	$37
Organizational membership	$200

All memberships are valid for one year from the date they are received. Please make check payable to NAMI Illinois. NAMI Jackson County is a not-for-profit tax-exempt Illinois Corporation.

Contact Information * Indicates required field

*Name

Title (if applicable)

Agency (if applicable)

*Address

*City *County

*State *Zip

Phone ( ) Fax ( )

Please print out this form at home and mail with your payment to:

NAMI Jackson County
c/o NAMI Illinois
218 West Lawrence
Springfield, Illinois 62704

Please make your check payable to NAMI Illinois.

7 May 2007