Please print and fill out the membership form and mail it to the address below along with $5 membership fee and/or your donation.
Georgia Mental Health Consumer Network, Inc.
246 Sycamore Street, Suite 260
Decatur, Georgia 30030

Name _____________________________________________________________________________________________





Address _________________________________________________________________________




City __________________________________     State_________  Zip________________________




County __________________________________________________________________________




Area Code (___________)  Telephone  _________________________________________________




Email ____________________________________________________________________________