Alzheimer Society

We still have room for 4 guests at this event.
The reservation limit per user is 2 guests.

* First Name

* Last Name

* Email

Yes, I would like to receive periodic updates and communications.

* Phone

Please specify the number of guests, including yourself, that will attend:

Please answer the following additional questions:

*1.	Question - Required - Help us serve you better, please identify if you are a:
*2.	Question - Required - Who is attending with you? (Maximum response 255 chars, approx. 5 rows of text)
*3.	Question - Required - Please provide us with an emergency contact, and identify the relationship to the participant. (Maximum response 255 chars, approx. 5 rows of text)
*4.	Question - Required - Where did you hear about this program?
*5.	Question - Required - What is your Date of Birth? (dd/mm/yyyy)
*6.	Question - Required - Can you please type in your preferred pronouns? (If you prefer not to disclose, please write "Prefer not to answer")
*7.	Question - Required - We wish to provide an inclusive and safe environment for participants who have a variety of needs. If participants require any extra assistance to meet their personal needs, we ask that they be accompanied by a care partner/caregiver to ensure meaningful engagement in our programming, as well as their safety and security. We cannot ensure the security of participants who walk about unsupervised if they wish to leave the group, and we cannot be responsible to arrange participants' transportation needs.

Would you like to receive an email reminder for this event?

Yes, email me a reminder