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
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Month
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Day
Year
Date
Select which seminar you wish to attend
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Family & Friends (informs and supports people who have loved ones with a mental health condition)
In Our Own Voice (insight into what it’s like to live with mental illness)
How did you hear about NAMI Utah and this presentation?
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Please select a date (2nd or 4th week of the month for Family and Friends) to attend the 90 minute seminar:
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Please select a date (1st or 3rd week of the month for In Our Own Voice) to attend the 60 minute seminar:
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Name
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First Name
Last Name
Age Group
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18-30
30-40
40-50
50-60
Over 60
Email
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example@example.com
Phone Number
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Area Code
Phone Number
Mailing Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Affiliate/County
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Emergency Contact
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First Name
Last Name
Emergency Contact Phone Number
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Area Code
Phone Number
I give NAMI Utah permission to send me emails (I can opt out at a later time):
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(Initial)
Submit
Should be Empty: