NAMI Membership Form
Please enter your full name. If purchasing a Household membership, list all members separated by a comma.
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How did you hear about us? *
Did a current NAMI member refer you to get a membership?
Please add their name so that we can thank them!
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Home Phone *
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Cell/Work Phone
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Email Address
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Let us know about you
Please check ALL that apply
Age of Primary Member
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