NAMI Westside Los Angeles
Pathways to Wellness - Our 4th Annual Mental Health Conference
May 22, 2011
Conference Professional Attendee Registration Form

  Please fill out the form below.  Your information will be kept confidential.
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
10:45 AM – 11:55 AM
 
SESSION TWO
12:20 PM – 1:30 PM
Attendee 2:
SESSION ONE
10:45 AM – 11:55 AM
 
SESSION TWO
12:20 PM – 1:30 PM

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

YES, contact me about special accommodations.

 

 
After you click "Send to NAMI" please continue to our secure payment site
to complete your registration.
NAMILA.org