1. Previous Address                                     New Address

NAMI ID#                                                      NAMI ID#                                

NAME                                                          NAME                                   

STREET                                                       STREET                                  

CITY                          STATE                        CITY                     STATE       

ZIP CODE                                                    ZIP CODE                               

PHONE#                                                      PHONE #                                  

2. Previous Address                                    New Address

NAMI ID#                                                      NAMI ID#                                

NAME                                                          NAME                                   

STREET                                                       STREET                                  

CITY                          STATE                         CITY                     STATE       

ZIP CODE                                                     ZIP CODE                               

PHONE#                                                       PHONE #                                  

Please return this form to your State Office for membership processing.

Questions? Feel free to contact NAMI Illinois (217) 522-1403