Name:_________________________________________________

Address:_______________________________________________

_______________________________________________________

_______________________________________________________

Phone:_________________________________________________ 

Email:__________________________________________________


____I am joining NAMI today
____I am renewing my NAMI membership

Annual membership dues is enclosed/attached (cash/check/money order)
in the amount of (check one):
____Individual/Family $35
____Open Door $3
____Other Gift $________

Newsletter preference:
_____I prefer to receive my NAMI SEAZ  "Update" newsletter by U.S. mail or

_____I prefer to access it online at www.namiseaz.org Newsletter (saves postage and copying costs)

Make check  payable to:     NAMI of Southeastern AZ

Mail in your membership form to:
NAMI of Southeastern AZ
77 Calle Portal, Suite A-280
Sierra Vista  AZ   85635

Questions?        Call Deanna at (520) 459-3228   or     e-mail    info@namiseaz.org