NAMI Westside Los Angeles
Pathways to Wellness - Our 3rd Annual Mental Health Conference
June 13, 2010
Student / Consumer / Financial Hardship Registration Form

  Please fill out the form below to register.  Your information will be kept confidential.
     
Registration Category:
If a Student, School You Attend:
   
Please register
 attendee(s) for the conference.
Attendee 1 Name: 

Address:

City & State:

ZIP Code:

Phone:

( ) Ext. Email:

Attendee 2 Name: 

Address:

City & State:

ZIP Code:

Phone:

( ) Ext. Email:
  How did you hear about the conference?
 
  My Workshop Choices

Attendee 1:
SESSION ONE
2:00 PM – 3:15 PM
 
SESSION TWO
3:45 PM – 5:00 PM
Attendee 2:
SESSION ONE
2:00 PM – 3:15 PM
 
SESSION TWO
3:45 PM – 5:00 PM

 YES, contact me about volunteering at the conference.
(State volunteering interests in the Comments Box below.)

YES, contact me about special accommodations.

 

 
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