Membership Form

New Mexico Coalition for Natural Health Membership Application

Name & Title: ____________________________________________

Home Address: ____________________________________________

City: _____________________State: ____________ Zip __________

E-mail: __________________________________________________

Day Phone: ______________________________________________

Work Phone: _________________________Fax: ________________

What is your Field of Expertise? _____________________________

Are you currently practicing natural health care? _________________

Yes, I want to join the New Mexico Coalition for Natural Health. As a member of
New Mexico CNH I pledge to support its mission and uphold the inherent right of natural health freedom.

Please choose your membership type:

$10 per year Student Membership: ______________
$20 per year Consumer Membership: ______________
$35 per year Professional Membership: ______________

I have enclosed a check for ____________made payable to the
New Mexico Coalition for Natural Health.

Print, Mail form & check to:

New Mexico CNH
NMCNH
P.O. Box 2611
Hobbs, NM 88241-2611

Contact us at: newmexico@naturalhealth.org

Web site:
www.naturalhealth.org/newmexico

E-mail:
newmexico@naturalhealth.org