NAMI Membership Form
Please enter your full name
How did you hear about us?
Word of Mouth
Healthcare Provider Referral
NAMI Program (please list)
Did a current NAMI member refer you to get a membership?
Please add their name so that we can thank them!
About You: Let us know who we're representing
Please check ALL that apply
person living with a mental illness
family member/friend (of an adult)
family member/friend (of a chid/adolescent
mental health or other provider
veteran or family member of a veteran
Age of Primary Member
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