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* 1. Name

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* 3. Phone (optional)

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* 4. What is your 5-digit zipcode?

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* 5. What is your racial or ethnic identity? (Select all that apply.)

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* 6. What is your age?

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* 7. Which of the following applies to you? Select all that apply.

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* 8. How did you first hear about this event?

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* 9. Do you want to be contacted about future MHRC/NAMI Lansing Events?

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* 10. Following the lecture, there will be a panel discussion related to mental health crisis care from experts in this field—including care providers, people with lived experience of a mental health crisis, etc. Are there any questions or topics you would like the panel to address?

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