VDT Request Form

Business/Organization Name*

Contact Name*

Indicate the person who should be contacted regarding this request.

Contact Email*

Contact Phone Number*

Program Audience*

Select or enter value

Estimated # of Participants/Employees Attending*

Minimum of 20 expected participants required to request the Virtual Dementia Tour

What date(s) would you like to hold the VDT?*

Please allow, at minimum, 3 weeks notice.

What time of day would you like to hold the VDT?*

Please note that you must reserve at least 4 hours for the Virtual Dementia Tour.

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