Expression of Interest Form

Expression of Interest

Fill the form below to follow the MEND Allies group and to receive more details on how to join us and contribute to our cause.
Name:*

PrefixFirst NameLast NameSuffix
E-mail Address:*
example@example.com
Phone Number:*

Area CodePhone Number
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Are you a mental health provider?*

PhDPsyDMDPNPLCSWLCASLMFTLPCPre-licensedI’m not a mental health providerOther
Racial Identity*

Alaskan native/Native AmericanAsianAfrican-American/blackWhiteHispanicLatinxMiddle EasternOther
Are you interested in becoming a MEND Ally?

YesNoUnsure
Any special talents or contributions that you are interested in lending to the mission?
Ally Donation

prevnext( X )
USDDescription
Solidify your interest in MEND with a financial contribution to our cause. At this time, we are allowing values-based contributions. While we have suggested a donation amount $125 per individual, we urge you to give based on your ability and the value that you place on seeing people of color liberated from the effects of trauma. Every single dollar that we collect moves us closer to a person in need of healing.

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.