Seminar Registration Form

Family and Friends Seminar Registration Form

Welcome! We at NAMI Utah are delighted that you are interested in our online Family & Friends 90 minute online Seminar. Please complete this registration form. You will receive an email from NAMI a couple days before the seminar explaining how to join the online seminar.
Today's Date *

Month Day Year
Date
Select which seminar you wish to attend *
How did you hear about NAMI Utah and this presentation? *
Please select a date to attend a seminar. *

Thursday, July 30 from 7 to 8:30 PM Thursday, August 13 from 7 to 8:30 PM Thursday, August 27 from 7 to 8:30 PM Thursday, September 10 from 7 to 8:30 PM Thursday, September from 24 7 to 8:30 PM
Name *

First Name Last Name
Age Group *

18-30 30-40 40-50 50-60 Over 60
Email *
example@example.com
Phone Number *

Area Code Phone Number
Mailing Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Affiliate/County *
I give NAMI Utah permission to send me emails (I can opt out at a later time): *
(Initial)
Applicant Signature: *

Clear
Should be Empty:

Family and Friends Seminar Registration Form