Organization Registration

Please fill out form with necessary information and click the submit button below.

Organization/Group Name	N.A.M.I. Northern Lakes Center
Primary Phone	1-715-420-1700
Primary Email	northernlakescenter@gmail.com
Address	235 N. Stevens Street Rhine., WI. 5
Address Ln 2	ATTN. Northen Lakes Center
City	Rhinelander
State	WI
Zip	54501

Individual Contact Information

First Name

Last Name

Cell Phone (Primary)

Phone (Alternate)

Department

Password (Minimum of 6 Characters)

Password (verify)

Cancel