NAMI  MEMBERSHIP APPLICATION  (Print out and mail)

CHOOSE ONE OF THE FOLLOWING:

	Family/Individual . . . . . . . . . . . . . . . . . . . . . . .$35.00
	Professional . . . . . . . . . . . . . . . . . . . . . . . . . .  $50.00
	Open Door: Consumers, Individuals, or Families w/Limited Income . $3.00
	Would you also like to make a contribution?
	Contribution  . . . . . . . . . . . .. . . . . . $ ___________

Name:_________________________________________

Company or Organization (Professional Membership ONLY)

        __________________________________________

Street:_________________________________________

City:__________________________________________

State_________________   Zip_____________________

Tel(H)______________________Tel(W)___________________

e-mail address:_______________________________________

Do you prefer to receive the Newsletter by:

e-mail  (saves us postage)

U.S. Mail

both e-mail & U.S. mail

Make check  payable to:  NAMI of BUCKS

We also gladly accept MasterCard and Visa:  ( please circle one)        

Credit card number_________________________________________________

Expiration date____________________________________________________

Name as it appears on card___________________________________________

Print and Mail to: NAMI of Bucks County
            c/o P.O. Box 355
            Warrington PA 18976

Questions?        Call our office 215-442-5637   or         e-mail your question to   info@namibucks.org