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2007 Membership Application

2007 Membership Application

Federal ID No.: 52-2128967

NACBHDD membership is organizational. Individuals within organizations are not required to join separately. Dues run from January 1 - December 31, 2006. The Membership Campaign is conducted from October, 2005 - April, 2006. Please review the graduated dues structure below and check the box that applies.

Name:
Title:
Organization:
Address:
City, State, Zip:
Phone:
Fax:
Email Address:
Category:
NACBHDD dues are based on the size of your organization's annual expenditure budget (most recently concluded fiscal year) for mental health, substance abuse, and developmental disabilities, or any combination of the three. Subtract any non-behavioral health portions of your budget (e.g. corrections, aging, social services). A 10% discount is available for counties with two or more members (e.g. single county with mental health and substance abuse authorities, both members of NACBHDD) Also, counties from states with 100% membership will receive a 10% dues rebate. Please circle the appropriate amount below to identify your dues:
Total MH/MR/SA Budget in Millions -- Membership Dues:	-or- State Associations - $375 Associate Members (Non-County Authority Members) - $375
Message (Optional):

Payment Information

You will receive an invoice 7-10 business days after submitting this form. After receiving the invoice, please mail your invoice with your check made payable to:

The National Association of County Behavioral Health Directors (NACBHDD)
c/o NACo
440 First Street NW, Suite 800
Washington, DC 20001