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NAMI San Diego - Membership Application

Let's work together to improve the quality of life for everyone affected by mental illnesses in San Diego.

NAMI San Diego
Attn: Membership
P. O. Box 710761
San Diego CA 92171-0761

Name: _____________________________________________________________

Street: _____________________________________________________________

City/State/Zip: _______________________________________________________

Email: _____________________________________________________________

Phones:  Home: _______________________   Work: _______________________

                 Cell: _______________________     Fax: _______________________

Send my newsletter via e-mail______

Dues include membership in and newsletters from NAMI National and NAMI California.

______ $40.00       Membership      New Member  [   ]       Renewal  [   ]

______ $75.00       Professional Member

______ $100.00     Organizational Member

______ I am requesting scholarship help for my membership
           (contact the Membership Secretary at (619) 584-5564 x 105)

I would like to make an additional contribution of $_______________ (unless otherwise specified, the first $40 of any donation is considered membership)

______ Please send me information about other ways I can help.

Payment by Check Make check payable to NAMI San Diego

Payment by Credit Card [   ]   Visa         [   ]   MasterCard Name as on Card: ___________________________________________ Card Number: ______________________________________________ Exp. Date: _______/_______       Amount $______________________ Signature: _________________________________________________

Donations are Tax Deductible-Federal Tax ID #33-0122462