Family-to-Family via Zoom Application for Enrollment

Please complete one application per individual to register for the free NAMI Family-to-Family class scheduled to begin on Wednesday, August 5, 2020 in Vacaville. Please note this is an 8-week program and the class will fill quickly. After your application has been received, one of the Family-to-Family teachers will contact you.
You may return this application by mail or email. Please use the address at the bottom of the application. The information received on this application will remain confidential.
Name:*
Address*
Street Address Address Line 2 City State ZIP Code
Telephone (Cell):
Telephone (Home):
Email*
Are you a NAMI member?*
- Yes
- No
If no, we encourage you to join. Membership is $40 single/$60 family. Go to http://www.namisolanocounty.org to join.
Applicant’s relationship to individual with diagnosis/symptoms:
The individual’s diagnosis (if applicable):
Age that the individual was diagnosed or symptoms began:
Individual’s current age:
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