Membership includes parents, professionals, and community ...
ACMH Membership Application
Name
Organization (if applicable)
Address
City ST ZIP
Phone County
Please join us in our efforts on behalf of children with mental health needs and their families. Your annual membership dues and donations are tax deductible and will be used for ACMH services, parent/youth scholarships and support.
MEMBER TYPE AMOUNT ENCLOSED
Parent MEMBER DUES $______
Student
Individual MEMBER DONATION $______
Professional
Organizational TOTAL ENCLOSED $______
MEMBER NEWSLETTER
Electronic Newsletter via Parent Listserv
E-mail:
I do not have internet access and would like a printed newsletter sent to me
Please complete and mail along with your payment to:
ACMH, 6017 W St Joe Hwy, Ste. 200 Lansing MI 48917
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ACMH MEMBERSHIPS
Parent $ 10.00
Student $ 10.00
Individual $ 35.00
Professional $ 50.00
Organizational $125.00
Retain this portion for your records
MEMBER DUES $
DONATION $
TOTAL $
DATE
Check/MO #
Your contribution is tax deductible.
ACMH is a nonprofit corporation
under IRS section 501(c)(3)
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