Alzheimer's Association Speaker Request

Alzheimer's Association Speaker Request

Thank you for your interest in requesting an Alzheimer's Association program for your community or organization. We offer a variety of different programs, so please note your interest based on your specific needs. The Alzheimer's Association requests that when able, you provide three (3) months advance notice to plan for each requested education program. Please note that it may take up to 10 business days to receive a response.

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

English

Spanish

Other

Preferred date of program (first choice)*

Preferred date of program (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 and virtually. Please note your interest in the delivery method of the requested program.*

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 prefers minimum participation of 15 participants for requested programs. What is your expected audience?*

5-10 registrants

10-20 registrants

20-40 registrants

40+ registrants

The Alzheimer's Association's education programs require certain technological equipment. Does your organization provide a laptop, speakers, and projector?*

Yes, my organization can provide the equipment noted

No, I my organization cannot provide the equipment noted

Please share any other relevant information or special requests as needed.

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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