Yes, I want to support the Missouri Partners in Crisis.  (Your information will not be shared with anyone else.)  Please print this form and complete it.  Send it to Missouri Partners in Crisis, P.O. Box 220714, St. Louis, MO 63122.

Last Name __________________________ First Name ________________ Organization (If Applicable) _____________________________

Street Address _____________________________ City _______________ State _____ Zip Code __________

Home Phone __________________ Alternate Phone ___________________ Email _____________________________________

My state senator is ___________________________  My state representative is ________________________________

rYes, I am willing to write letters to the editor of my local newspaper urging funding for more mental health and substance abuse services.

rYes, I am willing to call or write my state legislators to tell them that Missouri is experiencing a mental health crisis and that we need to restore funding to the Dept. of Mental Health.

rYes, I am willing to attend meetings of the Missouri Partners in Crisis, Mental Health Commission, or Dept. Of Mental Health and speak out for people with mental illness or substance abuse problems. 

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