Active Minds 2022 National Conference On-Demand Content Access

Thank you for your interest in purchasing access to the Active Minds 2022 National Conference content. Follow the directions below to register: Virtual Registration: $35 If you have any questions, please email conference@activeminds.org. Please use Chrome, Firefox or Safari browsers to register (Do NOT USE Internet Explorer)

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Attendee #1 Details

General Information (as you would like to appear on your name tag)

First Name

Last Name

Title (or enter "student" if applicable)

Organization/School Name

Pronouns (If you'd like them included on your name tag)

Contact Information

Email address

Phone number

Street Address

City

State

Other State:

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Accessibility

We strive to host inclusive and; accessible events that enable all individuals to engage fully. Please include any accessibility services, pursuant to the Americans with Disabilities Act, that Active Minds can provide to the event venue to assist with your experience. If we have any questions an Active Minds staff person will be in contact with you prior to the event.

Tell us about you

Which of the following best describes your role in this setting?

Student leader (including Active Minds chapter members, fraternity and sorority leaders, student body presidents, and all other students committed to mental health awareness and suicide prevention)High School Staff, Teacher, or AdministratorCollege/University Staff, Faculty, or AdministratorParent or CaregiverCorporate, Nonprofit, Government, or Foundation RepresentativeMental Health Practitioner Active Minds Chapter Alumni Other

Other

I am a:

Graduation Year

Active Minds Chapter

What is your current gender identity? (Check all that apply)

WomanManTrans womanTrans manGenderqueer/nonbinaryAnother gender identityPrefer not to answer

Other gender identity

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Black/African AmericanHispanic/LatinxEast/Southeast AsianAmerican Indian/Alaska NativeNative Hawaiian/other Pacific IslanderMiddle Eastern/North African/ ArabSouth AsianWhiteOther (please Specify)Prefer not to answer

Other ethnic/racial identity

Please check any of the following for which you identify.

Foster youthVeteranLGBTQ+First generation college student

Attendee #2 Details

General Information (as you would like to appear on your name tag)

First Name

Last Name

Title (or enter "student" if applicable)

Organization/School Name

Pronouns (If you'd like them included on your name tag)

Contact Information

Email address

Phone number

Street Address

City

State

Other State

Zip

Accessibility

Tell Us About You

Which of the following best describes your role in this setting?

Other

I am a:

Graduation Year

Active Minds Chapter

What is your current gender identity? (Check all that apply)

WomanManTrans womanTrans manGenderqueer/nonbinaryPrefer not to answerAnother gender identity

Other gender identity

What racial or ethnic identity do you most identify with? (Check all that apply)

Black/African AmericanHispanic/LatinxEast/Southeast AsianAmerican Indian/Alaska NativeNative Hawaiian/other Pacific IslanderMiddle Eastern/North African/ ArabSouth AsianWhiteOther (please Specify)

Other ethnic/racial identity

Please check any of the following populations for which you identify.

Foster youthVeteranLGBTQ+First generation college student

Attendee #3 Details

General Information (as you would like it included on your name tag)

First Name

Last Name

Title (or enter "student" if applicable)

Organization/School Name

Pronouns (If you'd like them included on your name tag)

Contact Information

Email address

Phone number

Street Address

City

State

Other State

Zip

Accessibility

Tell Us About You

Which of the following best describes your role in this setting?

I am a:

Active Minds Chapter

Graduation Year

Other

What is your current gender identity? (Check all that apply)

WomanManTrans womanTrans manGenderqueer/nonbinaryPrefer not to answerAnother gender identity

Other gender identity

What racial or ethnic identity do you most identify with? (Check all that apply)

Black/African AmericanHispanic/LatinxEast/Southeast AsianAmerican Indian/Alaska NativeNative Hawaiian/other Pacific IslanderMiddle Eastern/North African/ ArabSouth AsianWhiteOther (please Specify)

Other ethnic/racial identity

Please check any of the following populations for which you identify.

Foster youthVeteranLGBTQ+First generation college student

Attendee #4 Details

Personal info (as you would like it to appear on your name tag)

First Name

Last Name

Title (or enter "student" if applicable)

Organization/School Name

Pronouns (If you'd like them included on your name tag)

Contact Information

Email address

Phone number

Street Address

City

State

Other State

Zip

Accessibility

Tell Us About You

Which of the following best describes your role in this setting?

Other

I am a:

Active Minds Chapter

Graduation Year

What is your current gender identity? (Check all that apply)

WomanManTrans female/trans womanTrans male/trans manGenderqueer/nonbinaryPrefer not to answerAnother gender identity

Other gender identity

Please check any of the following populations that you identify with:

Foster youthVeteranLGBTQ+First generation college student

What racial or ethnic identity do you most identify with? (Check all that apply)

Black/African AmericanHispanic/LatinxEast/Southeast AsianAmerican Indian/Alaska NativeNative Hawaiian/other Pacific IslanderMiddle Eastern/North African/ ArabSouth AsianWhiteOther (please Specify)

Other ethnic/racial identity

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Active Minds is the nation's premier nonprofit organization promoting mental health for young adults.