B: NAMI Wisconsin Mental Health Chat, September 2019 (9:30 am - 3:00 pm) Location: NAMI Fox Valley Office211 E. Franklin StAppleton, WI Question Title * 1. Participant Contact Information Participants First and Last Name City/Town you live Email Address (required) Phone Number OK Question Title * 2. For which NAMI Affiliate will you be taking this training? NAMI Barron NAMI Brown Co NAMI Chippeway Valley NAMI Dane Co NAMI Dodge Co NAMI Door Co NAMI Douglas Co NAMI Fond du Lac Co NAMI Fox Valley NAMI Green Co NAMI Jefferson Co NAMI Kenosha NAMI La Crosse NAMI Manitowoc Co NAMI Monroe-Juneau NAMI Northern lakes NAMI Northwoods NAMI Northern Lakes NAMI Oshkosh NAMI Ozaukee NAMI Portage-Wood Counties NAMI Racine NAMI Rock NAMI Sauk NAMI Southwestern NAMI St. Croix Valley NAMI Trempealeau Co NAMI Vernon Co NAMI Walworth Co NAMI Washington Co NAMI Waukesha OK Question Title * 3. To take this NAMI Wisconsin training you need approval from your affiliate, please list the person from your affiliate that invited you to participate in this training? OK Question Title * 4. Mental Health Chat is a training targeting elementary students grades 3 - 5 to discuss mental health and reduce the stigma of seeking help. Are you a consumer, family member, or friend of someone who identifies as living with a mental illness? Consumer, identifies a someone living with a mental illness Family member Friend other OK Question Title * 5. This training will be from 9:30 am - 3:00 pm. Lunch and all materials will be provided as part of the training but transportation to and from the training, any hotel needed and all other meals will be the responsibility of participants or their affiliate. Please type your initials to acknowledge this information. OK Question Title * 6. Should we be aware of any physical accommodations for you to participate in this training? Yes (Please explain below) No Yes (please specify) OK Question Title * 7. NAMI Wisconsin will send you a confirmation email 6 weeks to a month prior to the training with more detailed information. This email will include some pre-reading and video you must review prior to the training. Thank you for your interest in reducing the stigma of Mental Health needs in your community elementary schools! OK Question Title * 8. Please share your t-shirt size. For example Ladies large, or Men's small. Thank you. OK PLEASE CLICK TO SUBMIT!