NAMI Membership Form

NAMI-Yolo Membership for 2007

Date: _________ New Member ___ Renewal ___

Name ___________________________________________ Phone (home)_________________

Street_______________________________________________________

City ______________________________ State ____ Zip ___________

E-Mail ______________________________________________________

We are always in need of volunteers. Please take a moment to mark the activities that interest you.

__ Potluck Hosting __ Fundraising __ Legislation __ Religious Outreach

__ Sunflower Art Exhibit __ Special Events Other ___________________________________________

Throughout the year, we will notify you of upcoming events and important issues unless you tell us otherwise. In some instances, we will use an automated phoning system. Please indicate the following:|

__ Notify me only about special events __ Please do not send newsletters or other literature.

__ Please do not phone me. __ Please email the NAMI-Yolo newsletter.

Annual Membership Dues

__	Corporate ............	$150
__	Benefactor ...........	$100
__	Patron .................	$ 50
__	Family* ................	$ 40
__	Individual .............	$ 35
__	Professional ..........	$ 35
__	Low Income...........	$ 15
__	Consumer .............	$ 3
__	Donation ..............	$______
	Total Amount***	$______

Make checks payable to & mail to:

NAMI-Yolo
PO Box 447
Davis, CA 95617
Phone (530) 756-8181

* If you have a Family membership and have family members residing at other addresses you want included on our mailing list, please list their names and address on a separate sheet.

*** Donations are tax deductible