Life Interrupted Speaker Training Registration Form

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Fill out this form to register for the Life Interrupted Speaker Training.

The training will be held Saturday, May 9th and and Saturday, May 16th from 9am to 3pm. You must attend both days.

The training will be held at NAMI NH, 85 North State Street, Concord, NH.

If you have any questions regarding the Life Interrupted Speaker Training, contact Susan Allen-Samuel at sallen@NAMINH.org or 603-225-5359 ext 328.

Email *

In order to participate in the Life Interrupted Speaker Training you must have a family member/friend that you have provided or currently are providing care/support for.

I have a family member/friend UNDER the age of 27 who is a consumer of mental health services.

I have a family member/friend OVER the age of 27 who is a consumer of mental health services.

First Name *

Last Name *

Phone Number *

Street Address

City

State

ZIP Code

Do you have any food allergies or sensitivities? *

A copy of your responses will be emailed to the address you provided.

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