Membership in NAMI Piedmont Tri-County is a requirement to attend some programs and classes (NOT ALL) at The HUT. Membership is as low as $5 a year. ALL MEMBERS MUST COMPLETE THIS FORM for Emergency Purposes. *
Do you live with a mental illness or are you a caregiver, family member or friend of someone who lives with a mental illness? *
Do you have a medical condition we need to know about? Anaphylaxis, seizure disorder, etc.? Confidential Information only to be used in the purpose of an emergency situation or need. Please type N/A if this does not apply to you. *
Emergency Contact, name and phone number *
Emergency contact number entered above *
By submitting this application you are agreeing to become a member of NAMI Piedmont Tri-County's Drop In Center at The Hut and all that entails. You agree to behave respectfully and with kindness and understanding to those who are also members of the NAMI Piedmont Tri-County Drop In Center. Any violence or crude/repetitive disrespectful language will result in suspension of privilege's at the Center. All applications will be digital and stored on the employees computer. We endeavor to maintain a secure digital environment but offer no liability or promise of privacy in the event of a breach. Please type you agree and understand the limitations of membership. *
A copy of your responses will be emailed to the address you provided.