Print this page and mail it today with your check.

I'm ready to join my friends and neighbors in promoting mental health in Benton County!

Name _____________________________________________

Address ___________________________________________


Phone _________________

Date __________________

I am interested in volunteer work with :

 The Board of MHABC  Other work of MHABC

Enclosed is my annual dues payment of:

 $50 (Corporate/business donor)  $40 (Non-profit organization)  $20 (Professional)  $15 (Individual)  $10 (Senior/Student)  $ 5 (Annual volunteers)  $ 5 (Newsletter subscription only)

 Please send a receipt for tax purposes.

Mail completed form & check to:

MHABC PO Box 1054, Corvallis, OR 97339