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Family to Family Registration
NAMI Northeast Region PA Family-to-Family 8 Week Education Program
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Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Street Address
*
Your answer
City/town
*
Your answer
Zip Code
*
Your answer
Phone
*
Your answer
Age
*
Your answer
What gender do you identify as?
Man
Woman
Transgender
Non-Binary/Non-Conforming
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What race best describes you?
American Indian or Alaska Native
Asian
Hispanic or Latino
Native Hawaiian or Pacisfic Islander
Black or African American
White
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What is your relationship to person with mental illness:
*
Your answer
What is their age?
Your answer
What is their diagnosis?
Your answer
How did you hear about the Family to Family class?
*
Flyer
Newspaper
Mental Health Porvider
Friend
Relative
Social Media
Email
NAMI Support Group
Other
I understand that this is an 8 week course and I am able to commit to all (most) of it.
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