DEPRESSION AND BIPOLAR SUPPORT ALLIANCE

                                                                       

WHO WE ARE

The DBSA-Dallas is small locally-run and funded organization run by volunteers who are directly affected by mood disorders. We receive no money from the National or State chapters of the DBSA, from other mental health support organizations or from governmental entities. Our support comes solely from individuals, or groups who choose to donate to us or to become members of the organization. Please support us in our mission of providing help, hope and healing to the multitudes who have in one way or another been impacted by depression and Bipolar Disorder.

CONTACT US
First name:
 * required
Last name:
 * required
 
Phone number:
Email address:
 * required
Best way to contact you:
 
Mailing address
(not required):
I am a member of the DBSA-Dallas

I am a:
 
Suggestions, topics you want the board to address:
ITEMS FOR THE AGENDA
 

I would like to put an item on the agenda:

Agenda item 1

Agenda item 2

Agenda item 3

Other items you would like to be on the agenda:

   

 

BECOME A MEMBER OF THE DBSA-DALLAS

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The DEPRESSION AND BIPOLAR
SUPPORT ALLIANCE - DALLAS

 
NAME:

 * required

MAILING ADDRESS:

 * required

CITY/STATE/ZIP

 * required

PHONE NUMBER

Regular Membership - $30 per year (individuals and family members)
Professional dues - $100 per year. (A professional is a doctor, nurse, social worker, or a medical p
I am mailing my dues

MAILING ADDRESS: DBSA/DALLAS, P.O. Box 224842, Dallas, Texas 75222.B

make checks/money orders payable to: DBSA/DALLAS

WE NEED YOUR FINANCIAL SUPPORT:  If you have not paid your DBSA/DALLAS dues in the past 12 months, please mail you membership dues to DBSA/DALLAS, P.O. Box 224842, Dallas, Texas 75222. Individual and family dues are $30 per year.  Professional dues are $100 per year. (A professional is a doctor, nurse, social worker, or a medical institution.)  All dues and contributions are tax deductible. Thanks!!
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I WOULD LIKE THE DBSA_DALLAS TO PROVIDE A SPEAKER  FOR A GROUP
(The DBSA-Dallas will provide speakers free of charge)

Contact Name:

Name of the organization or group:

 * required

Position in organization or group

 * required

Number of people Expected to attend

5-10
10-20
20+
 * required

Type of Audience:

Individuals with Mood Disorders
Significant Others of People with Mood Disorders
Community Group Members
Healthcare Professionals
Students
Church Members
General Public

I would like someone who is a:

Location of proposed speaking engagement:
Phone:
Home
Cell
Business

How would you like us to introduce ourselves on the phone?

Email Address:
Mailing address:

I WOULD LIKE THE DBSA_DALLAS TO PROVIDE A SPEAKER  FOR A GROUP
(The DBSA-Dallas will provide speakers free of charge)

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