Alzheimer's Association Speaker Request

Alzheimer's Association Speaker Request

Thank you for requesting to host an Alzheimer's Association program, please provide as much detail as possible. The Alzheimer's Association asks that, when possible, you provide three (3) months advance notice to plan. Please note that it may take up to 10 business days to receive a response.

As a host location, please review the below guidelines in order to host a successful program. Guidelines

I have reviewed and agree to the Alzheimer's Association Education Program Host Guidelines.*

Program Type*

Awareness Presentation Description; Education Program Menu

Select or enter value

What language are you requesting the program to be delivered in?*

English

Spanish

Both

Audience*

General Public

People Living with Dementia

Family and friends care partners

Healthcare Professionals

Other Business/Organization (please be specific in comments section)

Requested date (first choice)

**Please note that we cannot guarantee preferred dates or times**

Requested date (second choice)

Preferred time of program

Name of Requestor*

Contact Email*

Yes, I would like to receive email from the Alzheimer's Association.*

Yes

Contact Phone Number

Phone

By entering your mobile number, you will be opted in to receive text message updates from the Alzheimer’s Association and stay involved in the fight to end Alzheimer’s. You will be able to opt-out of these messages at any time. See our Privacy Policy.

Name of Organization*

Street Address*

City*

State*

Select

Zip*

Alzheimer's Association programs are delivered in-person or virtually. Which format are you requesting?*

I am interested in an in-person education program

I am interested in a virtual education program

I am interested in an in-person or virtual education program

The Alzheimer's Association requests a minimum of 15 pre registered participants for programs. What is your expected audience?*

10-20 registrants

20-40 registrants

40+ registrants

The Alzheimer's Association's education programs require certain technology such as a projector/screen/HDMI connectors and speakers. Does your organization provide equipment?*

Yes, my organization can provide equipment

No, my organization cannot provide equipment

Please share any other relevant information or special requests as needed. The more details you can provide now, the easier it will be to schedule your program.

By providing this information and clicking the "Submit" button, you acknowledge and consent to the terms of the Association's Privacy Policy.

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