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