Online NAMI Connection Recovery Support Group Registration Form

Online NAMI Connection Recovery Support Group Registration Form
NAMI Southern Nevada’s Virtual Connection Recovery Support Group is a free, confidential support group for any adult experiencing symptoms of a mental health condition. Virtually every Thursday 6:00pm - 7:30pm.
- Participants learn they are no longer alone and gain a renewed sense of hope by joining a caring group of people who help one another through their learned wisdom.
- Meetings are led by trained facilitators who are living with a mental health condition or symptoms.
Safety: Emergency contact and your address must be filled in order to receive your invite to the group. Please contact us if you have any questions about this.

Confidentiality: Support group participants discuss personal and sensitive information that requires that privacy and confidentiality be upheld by all participants and facilitators. The only exceptions to confidentiality are times when an individual is at risk of immediate danger to him or herself or others.
Zoom Link and Registration Information

Registration is not automatic. We manually process all registrations on Wednesday afternoons. You will receive the Zoom link via email by Thursday before 4 PM for the 6 PM support group that night.

Registration forms must be submitted by Wednesday at 2 PM to attend that week's support group. If you register after this time, your registration will be processed for the following Thursday’s meeting.

If there are any errors in your registration (e.g., incorrect address or missing emergency contact), we will contact you and your Zoom link will be delayed until the issue is resolved.

If you have concerns about your application or questions about filling out the information below, please contact Peer Programs Manager, Sariah Nokes via text at 725-238-1402 or email us at supportgroups@namisouthernnevada.org
YesNo
Full Name*

First NameLast Name
Nickname
If you prefer a nickname to be used during the group, please indicate it here.
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Phone Number
Email Address*
example@example.com
13-1818-2425 and older
Safety and Contact Information

Your contact information will remain private and confidential to your respective Connection Facilitators, the Program Coordinator, and Support Groups Intern, and Emergency Contact.
Your Residential Address (Must include Street Number, Street Name, Unit Number, City, State, and Zip Code). NOTE: WE CANNOT REGISTER INDIVIDUALS WITHOUT ALL PARTS OF YOUR RESIDENTIAL ADDRESS. Information you provide is only referenced in the case of Emergency*

Street Address

Street Address Line 2 (including Unit or Apartment # if applicable)

CityState / Province

Postal / Zip Code
Emergency Contact Person Name*

First NameLast Name
Emergency Contact Phone Number (MUST be a different number than the one you have provided for yourself)*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contact Phone Number (MUST be a different number than the one you have provided for yourself)
Emergency Contact Email Address*
example@example.com
YesNo
YesNo
Email and Text Reminders
Receive only emails about NAMI Support Groups (Reminders with Zoom Access, Cancelations, Changes, Materials, etc.)Receive Support Group Reminders and Updates along with occasional NAMI Upcoming Events and Opportunities
Receive only text messages about NAMI Support Groups (Reminders with Zoom Access, Cancelations, Changes, New Groups, etc.)Receive text messages for Support Group Reminders and Updates along with occasional NAMI Upcoming Events and Opportunities
Yes, I recognize that.
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Online NAMI Connection Recovery Support Group Registration Form

Safety and Contact Information

Email and Text Reminders