NAMI North Carolina

Affiliate Leaders Address and Telephone Contact Update Form

 

 

Affiliate Information 

Affiliate Name:                                                                                                             


                     Mail to Affiliate should be sent to the President’s address

Or

  Mail to Affiliate should be sent to the following address

Name:                                                                                                                                       

Address:                                                                                                                                 

Phone (Daytime):                                                           (Eve.)                                                

E-mail Address:                                                                                                                         

President                    Name:                                                                                                   

Address:                                                                                                                                  

Phone (Daytime):                                                           (Eve.)                                                

E-mail Address:                                                                                                                       

 

Treasurer                     Name:                                                                                                             

Address:                                                                                                                                  

Phone (Daytime):                                                           (Eve.)                                                

E-mail Address:                                                                                                                       


Member who is Legislative Liaison (if any)               Name:                                                            

Address:                                                                                                                                              

Phone (Daytime):                                                           (Eve.)                                                

E-mail Address:                                                                                                                       

 *please make copies for your future updates.