Alzheimer Society

We still have room for 64 guests at this event.
The reservation limit per user is 1 guests.

First Name, Last Name and Email

* First Name

* Last Name

* Email

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

Street Address, City, Province, Postal Code and Phone number

* Street 1

Street 2

* City

* Province/State

* Postal/ZIP Code

* Phone

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

Please answer the following additional questions:

*1.	Question - Required - To help us serve you better, please tell us if you are the caregiver of your:
2.	Question - Not Required - If you answered "Other", please indicate your relationship with the person with dementia (Maximum response 255 chars, approx. 5 rows of text)
3.	Question - Not Required - Is this your first time attending the caregiver education forum hosted by the Alzheimer Society, Scarborough Health Network and the Ontario Caregiver Organization?
4.	Question - Not Required - When it comes to planning ahead in caring for someone with dementia, what questions do you have? (Maximum response 255 chars, approx. 5 rows of text)
*5.	Question - Required - If available, would you like the presentation slides to be sent to you? Yes No

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

Yes, email me a reminder