First Name
Last Name
Email
Title
Company
Select a registrant Type Please select Partner Member Non-Member Peer Youth NAMI HQ guest speaker
Phone Number
Address
Will you be staying at the Kimpton Hotel Monaco? Please select Yes No
How did you hear about this year's Partner Summit? (Select all that apply) Please select NAMI Affiliate NAMI Email NAMI Publication NAMI Website Social Media Family/Friend Other Other
How did you hear about this year's Inspiring Hope through Research Event? (Select all that apply) Please select NAMI Affiliate NAMI Email NAMI Publication NAMI Website Social Media Family/Friend Other Other
Which of the following BEST describes you? (Pick One) 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
How many Partner Summits have you attended?
How many Inspiring Hope through Research events have you attended?
What aspects of the summit are most appealing to you? (Select all that apply) Please select Networking opportunities Updates on new research Updates on new policy initiatives Updates on NAMI programs None of these
Do you plan to attend the Partner Summit (Day 1) on Monday, September 9th from 9 am to 4 pm? Please select Yes No
Do you plan to attend the Welcome Reception on Monday, September 9th from 4:30 pm to 6:30 pm? Please select Yes No
Do you plan to attend the Partner Summit (Day 2) on Tuesday, September 10th from 9 am to 12 pm? Please select Yes No
Do you plan to attend Dr. Christine Crawford's book launch on Tuesday, September 10th from 2 to 4 pm? Please select Yes No
Do you plan to attend the Inspiring Hope through Research event on Tuesday, September 10th at 6:15pm? Please select Yes No
Do you have any dietary restrictions? Please select None Gluten intolerance Dairy intolerance Vegetarian Vegan Severe Allergies (nuts, shellfish, etc.) Other Other
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
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
Have you ever served on active duty in the U.S. Armed Forces, Reserves or National Guard? 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 Other
Please select OPT IN if you would like to share your contact info with local NAMI Affiliates and/or State Organizations:
