NARMH- New Membership

New Membership Form

Red items must be completed to best serve you.

Name:

First

Last (For group membership, enter other names below)

Profession

Organization:

Address:

City:

State:

Zip:

Telephone:

Fax Number:

Email:

Membership type (see description below):

		$65 Individual Membership		$30 Retired Membership
		$175 Organizational Membership		$30 Student Membership
		$350 Large Group Membership		$30 Consumer Membership
		$1000 Sponsor Membership
		Donation
		Additional contribution to help with work in promoting rural mental health and in developing, enhancing and supporting mental health services and providers in rural areas.

Large group membership names: [top]

Membership categories: [top]

Organizational Membership - $175
• One individual will be the primary contact for the group
• Five individuals will be allowed to be part of the group including the primary contact
• All group members will receive RMH
• All group members will receive selected mailings
Large Group Membership - $350
• One individual will be the primary contact for the group
• Ten individuals will be allowed to be part of the group including the primary contact
• All group members will receive RMH
• All group members will receive selected mailings
Sponsor Membership - $1000
• One individual will be the primary contact for the group
• Fifteen individuals will be allowed to be part of the group including the primary contact
• All group members will receive RMH and other mailings
• Sponsors would be identified on certain correspondence as sponsors/supporters of NARMH
• Sponsors will receive a plaque
• Sponsors will be given free exhibit space at the annual conference
• Sponsors will be provided with a free ad per issue in RMH

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	© National Association for Rural Mental Health 300 33rd Ave. S., Suite 101, Waite Park, MN 56387 - 320.202.1820, FAX: 320.202.1833 * Email: info@narmh.org	last update: 06.10.2007