BECOME A MEMBER OF NAMI-WCI TODAY!

You may become a member or renew your membership by telephone or by filling out and printing this form and sending it to the address below.

National Alliance on Mental Illness - West Central Indiana
P.O. Box 6232
Lafayette, Indiana 47903-6232
Phone: 765-423-6939 Fax: 765-423-6092

Name

Address

City/State/Zip

E-mail Address Phone

(NAMI-WCI does not sell or rent its mailing list)

MEMBERSHIP

You receive membership in our national and state organizations, a subscription to NAMI's quarterly newsmagazine, The Advocate, and reduced registration fees at the state and national annual conferences.

Sustaining, $120

Contributing $75

Active, $50

Consumer, $3

Please check here if this is a membership renewal.

*All membership fees are tax-deductible to the fullest extent of the law.
NAMI-WCI is a 501(c)(3) organization

Select Payment type:

Cash
Check (made payable to NAMI-WCI)
Visa Mastercard Discover
Card#: Exp. Date (xx/xx): (NAMI-WCI will not release your personal information to anyone.)

Signature:_____________________________________

Print this form and mail or fax to NAMI-WCI at the above address.

Thank you for your generosity! You will receive a receipt for your gift shortly.

Home * Mission * Awards * Support NAMI * Events

Support Groups * Discussion Board * NAMI-WCI Programs * Stigma Update

President's Corner * More Mental Illness Info * Newsletters * Contact Us

Web Design by Teresa Raymond.

For technical support with the website, contact at email