Help Make Vermont a State of Mental Health

Your membership with the Vermont Association for Mental Health helps us to maintain a strong and independent citizen's organization which is working to promote mental health and mental health services in Vermont.

Please print and fill out the form below and mail it, along with your tax-deductible contribution to :
Vermont Association for Mental Health
P.O. Box 165
Montpelier, VT 05601


Thank You!

Vermont Association for Mental Health Membership Form

Level:

$20.00 Individual Membership
$35.00 Family Membership
$50.00 Patron Club Membership
$100.00 Century Club Membership
$500.00 Major Subscriber Membership
Other
Camp Daybreak Scholarship Fund
(Full Scholarship is $180.00)

Name:

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Last
Address:

Number and Street

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State:
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Telephone:

Home: area code
and number

Business: area code
and number
 

Fax: area code and number
 
E-mail:
Comments:

 



©2002 Vermont Association for Mental Health