NAMI California Advocacy Interest Form

Thank you for your interest in advocacy with NAMI California! By providing your information below, we will send you any NAMI California Advocacy updates (i.e. newsletters, upcoming events, etc.,). We appreciate your time!

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. What is your e-mail address?

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* 4. What is your phone number?

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* 5. City, State

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* 6. County

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* 7. Age

Under 18

18-24

25-34

35-44

45-54

55-64

65+

Decline to state

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* 8. Specify your cultural and/or ethnic background

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* 9. I identify as... (please check all that apply)

Individual living with a mental health condition

Family member or loved one of an individual living with a mental health condition

Health Provider

Student

Social Worker

Educator

Service Administrator

Advocate

Other (please specify)

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* 10. Please list any other diverse communities you identify with (i.e. LGBTQIA+, Older Adult, Foster Care Youth, Veteran, etc.,)

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* 11. Have you advocated with NAMI California or a NAMI Affiliate before?

Yes

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* 12. I'm interested in... (check all that apply)

Writing letters

Participating in legislative visits

Attending a committee hearing in support of a bill

Attending an advocacy day at the Capitol

Attending state agency and/or commission meetings related to mental health

Attending a regional NAMI meeting

Participating in local NAMI meetings and/or events