NAMI Greenville, SC
2320 E. North St., Ste. L
Greenville, SC 29607-1250

 ____Renew Affiliate Membership   ____New Membership   _____Donation 

Full Membership for Local, State, & National: __$35 Affiliate __$5 Consumer

Enclosed is my gift:   __$35   __$50   __$100   __$200    Other $______

I am paying with:  __Check  __Visa  __MasterCard  __Discover  __Other

Credit Card # is: ________________________   

Expiration Date: ___/___/______   

Signature: _________________________________________________

MEMBERSHIP FORM:

Name ____________________________________________________________

Address ______________________________________________ Apt.# ______

City ________________________________    State ___    Zip ________-______

Phone #s  (_____) _____-________,   (_____) _____-________  

First Name (or Names) of Consumer ____________________________________

E-mail Address _____________________________________________________

Total Amount Enclosed  $_____________________________________________

Your Contribution to NAMI Greenville is tax deductible as provided by law.  NAMI is a not-for-profit 501 (C) (3) organization.  Make Checks/Credit Card donations out to NAMI Greenville.

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