NLBHA Membership Application

 

National Latino Behavioral Health Association

NLBHA needs your support and membership to have a more powerful voice and presence on national behavioral health issues of concern to Latinos. Together we can address the challenges that lie ahead to ensure mental health and substance abuse services are socially, culturally and linguistically competent and effective for our community.

Print this membership form and send it with a check (see bottom of form for amount) to:

A Marie Sanchez, Director of Programs and Membership
The National Latino Behavioral Health Association
P O Box 387, Berthoud, CO 80513
Ph: 970-532-7210
Fax: 970-532-7209

 

Name:
Title:
Organization:
Address:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip:
Phone:
Fax:
email:

Choose one:

Individual (non-mental health) $50
Consumer/Family Member $15
Youth $10
Organizational $150

Print this membership form