EmailMe Form - NAMI Emerald Coast Support Groups Registration

NAMI Emerald Coast Support Groups Registration

In efforts to ensure online safety and with guidance from our national organization, NAMI is now requiring advance registration for online support groups, classes, presentations, and events. The registration process allows NAMI facilitators to ensure that the participants in our support groups and classes are actually there FOR our support groups and/or classes.

You only need to register once to receive information on how to join the meetings whether virtual or in-person. Participants can attend as many appropriate support groups or classes that fit their particular situation or needs. Please be sure to check ALL appropriate groups or classes you would like to register for below.

NAMI Emerald Coast will ensure your information remains confidential and not to be sold to any other outside parties.

Registrant's Name *
First Last
Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
County *
Phone *
### - ### - ####
Email *
Which Support Groups are you interested in?
Family Support Group
NAMI Connection Recovery Support Group
Military Family Support Group
LGBTQIA+ Connection Recovery Support Group
Sisterhood of Shared Experiences
Are you or a family member have been or currently a member of the armed forces?
Yes
No
Emergency Contact Name
First Last
We also request (not require) you submit emergency contact information. This is for your own safety and for the safety of others. Your personal information will not be shared for any reason other than an emergency situation.
Emergency contact relationship to registrant
Emergency Contact Phone Number
How did you find out about NAMI Emerald Coast?
By registering and entering your first and last name below, you give us permission to send you information regarding support groups, classes, presentations, and events. You can unsubscribe at any time. *
First Last
Date *
MM / DD / YYYY