Your NAMI Affiliate or County of residence___________________________
Name of person if someone asked you to participate. ______________________

Each flower you sponsor requires a minimum donation of $35.00.

Feel free to print multiple copies of this form as needed.  (Ask your friends & relatives to sponsor flowers, too.)  Individuals who find sponsors for 5 or more flowers will receive a special iris pin commemorating the event.

Amount Due:                                    $  35.00 (each flower)
      Number of  Flowers: _____

                  Total for Flowers:           $________   
                  Additional Donation:      $________
                  Total Enclosed:               $________

Please make checks payable to  NAMI NC., and mail this form with your check to:
NAMI NC, 309 West Millbrook Rd., Suite, 121, Raleigh,  NC  27609

Your Name:_______________________________________________________
Mailing Address:___________________________________________________
City_________________________________, State_____  Zip  _________
Email address:_______________@____________ Phone (       )  _____________

Flower No. 1
Circle One:    In Honor     In Memoriam        Anonymous
Circle One:     Iris           Tulip            Daisy

Name of Person Honored: _______________________________________________
Address (for card-optional):_______________________________________________
City_________________________________, State_____  Zip  _________
Release to publish your name & name of person honored:   yes______no_____
Your signature: ___________________________________________________ 

____Please keep my flower(s) and use it (them) for the next NAMI fundraiser and awareness campaign. 

____I would like to keep the flower (s) I am sponsoring and plan to  pick it (them) up after the last installation.  Please notify me when available.