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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.

Dues rates, as of July 1, 2017:

   Household membership

$60

   Single membership

$40

   Open Door membership

$5

 (for persons experiencing financial constraints)
 

Please make check payable to NAMI Illinois. 
All memberships are valid for one year from the date they are received. 
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                                         

Email                                                                                                 

Phone  (         )                                        Fax  (        )                                         

 

Please print this form 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. 

30 May 2017