NAMI Lubbock Membership

___    Individual/Family Membership $20 

___      Benefactor $50 +  

___      "Open Door" (limited income)  $5  

___      Professional Association $25

___      New Member

___      Renewal

Name ______________________________________           

Address ____________________________________      

City ______________  State _________  Zip _______          

Home Phone  ____________  Work Phone__________           

Email Address ________________________________          

Permission to publish name as member?  YES   NO                       

Membership includes NAMI Texas and NAMI (National).          

NAMI Lubbock is a non-profit organization.  All annual dues and contributions are tax deductible.  Please make checks and money orders payable to:                                            

NAMI Lubbock, Inc.  Mail to: NAMI Lubbock, Inc.                   

P.O. Box 6854, Lubbock TX 79493-6854                        

__  I am a mental health consumer

___ I have an adult child with a  mental illness

___ I have a minor child with a mental illness

___ I have a sibling with a mental illness

___ I have a spouse with a mental illness

___ I have a parent with a mental illness

___ I have a friend with a mental illness

___ I am a professional care provider

Mental Illnesses I am interested in:

__ Bipolar Disorder

___ Depression

___ Schizophrenia or Schizoaffective

___ OCD and/or Anxiety Disorders

     Other ___________________