NAMI of GREATER CHICAGO

ALLIANCE FOR THE MENTALLY ILL

1536 West Chicago Avenue, Chicago, IL 60622

Phone: (312) 563-0445                                                         Fax: (312) 563-0467

 

Name______________________________________________________________

Address ___________________________________________________________

City______________________________State____________Zip_______________

Phone Number: (______) ________________________________

Email Address: ____________________________________________

 

MEMBERSHIP        

     __ New   __ Renewing

__ $55 Individual / Family

__ $100 Sustaining

__ $100 Mental Health Professional

__ $250 Sponsoring

__ $250 Organization / Institutional

__ $500 NAMI-GC 500 Club

 

For Consumers of Mental Health Services

__ $15 Consumer Club Membership

 

Relationship to Mental Illness - (optional)

__ Parent __ Sibling __ Spouse __ Child

__ Self  __ Friend __ Professional __ Other

DONATION:   $___________

Please earmark for...

__  Unrestricted

__  Endowment Fund

__  Information & Referral

__  Anti-Stigma Activities

__  Children & Adolescent

__  Older Adults

 

     ALSO... May we contact you about?

__  Volunteer Opportunities

__  Planned Giving

__  My employer ____________   has a matching gift program.

 

 

 

MEMORIAL OR TRIBUTE

This gift of $________       __ in memory of:

__ in honor of:

__ on occasion of: ________________________________

 

Notify the person(s) below of this memorial or tribute gift:

(The amount will not be disclosed).

Name _______________________________________________________________

Address______________________________________________________________

City_______________________________State ___________Zip ________________

 

 

CREDIT CARD PAYMENT OPTION:

Please charge $______ to my __ VISA __ MasterCard # __________________________

Exp. Date __________________ Signature ___________________________________

 

 

NAMI of Greater Chicago / The Alliance for the Mentally Ill advocates and educates on behalf of people with serious mental illness and their families.  Membership in NAMI of Greater  Chicago brings you the newsletter and other information about support groups, educational meetings, seminars, and check-out privileges for the David Ash Witheridge Library and its materials on mental illness.  Membership contributions to NAMI of Greater Chicago automatically enroll you as a member of the National Alliance for the Mentally Ill (NAMI) and NAMI of Illinois – the state organization.

 NAMI-GC is a not-for-profit 501(c)(3).  Your contributions are tax deductible as provided by law.

THANK YOU FOR YOUR GENEROUS SUPPORT!