If you would like to become a member of NAMI-DKK (Dekalb, Kane South & Kendall Counties),

please print out this form, complete it and send it to NAMI-DKK, 400 Mercy Lane, Aurora, IL 60506

along with your check or money order:

Name:________________________________________________

Address:__________________City:______________Zip:________

Telephone(s):__________________________________________

Family membership: $35/year _______

Single membership: $30/year _______

Friend of NAMI:         $30/year _______

Corporate:                 $75/year _______

Consumers:               $1/year   _______

Additional Gift:           $ _____________

Total Enclosed:          $ _____________