Seminar Registration Form

Seminar Registration Form

Welcome! We at NAMI Utah are delighted that you are interested in our 50-90 minute online seminars. 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 (2nd or 4th week of the month for Family and Friends) to attend the 90 minute seminar: *

November 11, 2021 7:00pm - 8:30pm December 9, 2021 7:00pm - 8:30pm December 23, 2021 7:00pm - 8:30pm January 13, 2022 7:00pm - 8:30pm January 27, 2022 7:00pm - 8:30pm
Please select a date (1st or 3rd week of the month for In Our Own Voice) to attend the 60 minute seminar: *

October 21, 2021 7:00pm - 8:00pm November 4, 2021 7:00pm - 8:00pm November 18, 2021 7:00pm - 8:00pm December 2, 2021 7:00pm - 8:00pm December 16, 2021 7:00pm - 8:00pm January 6, 2022 7:00pm - 8:00pm January 20, 2022 7:00pm - 8:00pm
Please select a date to attend the Ending the Silence for staff 60 minute presentation: *

August 30, 2021 1:00pm - 2:00am (Closed presentation for Spy Hop Navajo Youth Mental Health Leadership Project)
Please select a date to attend the Ending the Silence for parents 60 minute presentation: *
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 *
Emergency Contact *

First Name Last Name
Emergency Contact Phone Number *

Area Code Phone Number
I give NAMI Utah permission to send me emails (I can opt out at a later time): *
(Initial)
Should be Empty: