fotmnyc
 
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policy faqs
 
 

Membership Form

 

Name:
Agency:
Address:
City:
State:
Zip:
County:
Home Phone:
Work Phone:
Fax:
E-Mail:
*required for processing
Please select one: 
Membership Level:

Individual  $15
Family  $20
Family Run Organization   $50
Organization    $75
Sponsor  $500
Other/Donation  

Members of the Federation of Families for Children’s Mental Health, please deduct $5 off individual and family memberships.

TOTAL OWED:
* Please submit form and follow directions to pay this amount safely and securely through paypal. Thank you!

 

 
 
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358 St. Marks Place, Suite 302, Staten Island, NY 10301 phone: (347) 682-4870 fax: (718) 447-6539
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ftnysA chapter of Families Together in New York State
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A chapter of The National Federation of Families For Children’s Mental Health
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