Storybank

Storybank

Alzheimer’s impacts everyone. When our community members choose to share their stories, it makes others feel less alone in their experiences. Fill out the Storybank form below and make a difference in the fight against Alzheimer’s. You may be highlighted on our social media channels, blog, or other print and media opportunities.

Your Name*

Your Email*

Address

City

State

Select

Zip*

Phone

Please select the role(s) with which you identify.*

Individual with memory loss

Family caregiver

Long distance caregiver

Healthcare professional

Family member of individual with memory loss

Friend to individual with memory loss

Alzheimer's Association Board Member

Alzheimer's Association Volunteer

Alzheimer's Association Staff

Please select all Alzheimer’s Association services you have used.

24/7 Helpline

Care Consultation

Early Stage Support Group

Early Stage Social Program

Education Program

Professional Training

Support Group

ALZ Connected

Please select the Alzheimer’s Association events you have attended.

Walk to End Alzheimer's

The Longest Day

RIDE to End Alz

Family Conference

Professional Conference

Hope on the Harbor

Advocacy Week/Advocacy Forum

Team End ALZ

Other

Please share your story.

How has Alzheimer's disease or dementia impacted your life?

Why should others raise funds and awareness for Alzheimer's disease?

What do you want others to understand about Alzheimer's disease or dementia who may not have experienced it first-hand?

Is there anything else you would like to share?

If you would like to be tagged on social media when possible, please list your handle(s) below.

I consent to be contacted by the Alzheimer’s Association for digital and media opportunities.*

By checking this box, I give the Alzheimer’s Association permission to use my story in Alzheimer's Association related materials, such as social media posts, blog stories, and media opportunities.

Send me a copy of my responses

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