To become a member of NAMI-DAC,

    Print out this form.
    Fill out the blank fields.
    Mail completed form with remittance (payable to NAMI-DAC)  to:

                Treasurer
                NAMI-DAC
                PO Box 1737
                Las Cruces NM 88004

In addition to the NAMI-DAC newsletter, Supporting, Professional, and Institutional members will receive
the national Advocate , filled
with lots of research news, and the New Mexico Amigo newsletters.
 

Last Name :_____________________________________________

First Name:_____________________________________________

City, State, ZIP:__________________________________________

Phone: (_____)_________-_________________________________
 

Please Check One:

___  Institutional Member. Please make my institution a NAMI-DAC Institutional Member. Enclosed is a check for $100.

___  Professional Member. Please make me a Professional Member of NAMI-DAC. Enclosed is a check for $40.

___  Supporting Member. Please make me a Supporting Member of NAMI-DAC. Enclosed is a check for $35.

___  Open Door Member.  Please make me an Open Door Member of NAMI-DAC. Enclosed is $3.
                                             Open Door members do receive the NAMI-DAC newsletter,
                                             but do not receive the National or State NAMI newsletters.