DBSA Confidential Membership with a year's subscription for monthly LIFE IN BALANCE
                                                Date_________________
		
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Street_____________________________  Night Phone (   )_______________

City/State ______________________________  9-Digit Zip_______________

Professional agency if applicable____________________________________

Indicate:   ___New Membership     ___Renewal     ___Change of address


     Bi-MONTHLY Life in Balance NEWSLETTERS FOR A YEAR:

___ Individual Membership $25.00

___ Family Membership $35.00 

___ Professional Membership $50.00.
    This includes 5 bi-monthly newsletters sent to 1 address.

___ Institutional membership $130.00.
    This includes up to 15 bi-monthly newsletters sent to 1 address.

Print added name/address or query--






     Check or money order payable to DBSA         $_________________
	 
	 Donation may be a gift membership, a     $_________________
	 contribution in memory or in honor of an
	 individual, family or organization.
	 
	 TOTAL Enclosed (Tax deductible)          $
	                                           =================

              Mail check or money order with this form to:

              DBSA  ·  P.O. Box 32531 · Detroit, MI 48232-0531

Allow four to six weeks for delivery to begin. Try a free issue of
Life in Balance by taking part in groups where newsletter is available
for newcomers only.