First Name
Last Name
Email
Select a registrant Type Please select Member Non-Member Peer Young Adult
Phone Number
Address
Will you be attending NAMI Alliance Day on Monday, June 3? Alliance Day is specifically designed for our NAMI State and Affiliate staff and volunteers. Please select Yes No
What is your primary area of work with NAMI? Choose one. Please select Board of Directors Executive Director Fundraising/Development NAMIWalks Program/Education Public Policy/Advocacy
What NSONA are you affiliated with?
How did you hear about this year's NAMICon? (Select all that apply) NAMI Affiliate NAMI Email NAMI Publication NAMI Website Social Media Family/Friend Other
How many NAMICon's have you attended? Please select 0 1-3 3-5 5-8 8-10 10+
Which of the following BEST describes you? Please select Individual living with a Mental Health Condition Family member or friend of an individual living with a Mental Health Condition Friend of an individual living with a Mental Health Condition Professional or paraprofessional providing service to individuals living with a Mental Health Condition Supporter/Champion of the NAMI Mission Prefer not to say
What aspects of the convention are most appealing to you? (Select all that apply) Networking opportunities Updates on new research Updates on new policy initiiatives Inspiration and encouragement from people who understand you Information and skills that will help me as a NAMI Leader New Ideas for working with my NAMI Affiliate or State Organization Information anbout effective services and programs Partnerships and connections with new organizations Workshops on topics that help me or a loved one None of these
Do you plan to attend the Welcome Networking Reception on Monday, June 3rd? Please select Yes, I plan to attend Welcome Reception No, I do not plan to attend the Welcome Reception
Do you plan to attend the NAMI Closing Night Event on Wednesday, June 5th? Note: One (1) ticket is included with the purchase of a full convention registration. Please select Yes, I plan to attend the Closing Night event No, I do not plan to attend the Closing Night event
Do you have any dietary restrictions? Please select None Gluten intolerance Dairy intolerance Vegetarian Vegan Severe Allergies (nuts, shellfish, etc.)
Please mention allergies
Do you have any accessibility requirements? Please select None Accessible reserved seating Accommodation for a service animal Accommodation for an assistant or companion Wheelchair/ Mobility Scooter access Sign language interpreter Foreign language translation Other Other
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Your answers to the following questions help NAMI provide support, education and advocacy to you and your communities.
These can be sensitive questions, which is why they are completely optional. NAMI takes your privacy seriously and always handles your data in a respectful and confidential manner. Your data will never be shared outside of NAMI in a way that makes you personally identifiable.
See our Privacy Policy for more info!
How old are you? Please select Under 18 years 18/24 years 25-34 years 35-44 years 45-54 years 55-64 years 65-74 years 75-84 years 85 years or older Prefer not to answer
What's your race, ethnicity, or origin? (Choose all that apply) American Indian or Alaska Native Asian Black or African American Hispanic, Latino or Spanish Origin Middle Eastern or North African Native Hawaiian or Other Pacific Islander White Prefer not to answer Other Other
Which most closely describes your gender? (Choose all that apply) Agender Man Nonbinary, gender fluid, or gender non-conforming Questioning/unsure Transgender Woman Prefer not to answer Other Other
What's your sexual orientation? (Choose all that apply) Asexual Bisexual Gay Heterosexual (straight) Lesbian Pansexual Queer Questioning/unsure Prefer not to answer Other Other
Have you ever served on active duty in the U.S. Armed Forces, Reserves or National Guard? Please select Never served in the military Only on active duty for training in the Reserves or National Guard Now on active duty On active duty in the past, but not now (veteran/former military) Prefer not to answer
Refund amount
Refund date
Refund Type Please select Partial Refund Full Refund
Internal Notes
NAMI is committed to providing a safe, productive, and welcoming environment for all meeting participants and NAMI staff.
Please check the box to acknowledge the terms: Ticket Type Select Ticket Member $324 - NAMICon 2024 Registration Non-Member $374 - NAMICon 2024 Registration Peer $229 - NAMICon 2024 Registration Young Adult $229 - NAMICon 2024 Registration 0.0
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