First Name Last Name Email Select a registrant Type Please select Member Non-Member Peer or 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
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