« All Events 2026 Educating Across America Tour: Burlington, VT July 15 @ 10:00 am – 1:00 pm EDT 2026 Educating Across America Tour: Burlington, VT Registration Form Name(Required) First Last Email(Required) Phone(Required)Street AddressCity, State, ZIP(Required) City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Please register as:(Required) Family Caregiver Sponsor AFA Member Organization Professional - Specify below (Attorney, Caregiver, Clinician, Social Worker, etc.) General Public Individual with Dementia Register as Professional Doctor/Nurse Professional caregiver Case manager/social worker Attorney Memory care/nursing home staff Other, please specify Register as other:Please describe your profession:How did you hear about our conference?(Required) AFA Website/Email AFA Newsletter Employer/Colleague Friend/Family Member Social Media (Facebook, LinkedIn, Twitter, etc.) Media outlets (TV, newspaper, radio, etc.) Post Card Organization (if applicable)Would your organization/agency like to become an AFA member?(Required)YesNoAlready a memberWould you like to get a free memory screening?(Required)YesNoWould your organization like to become an AFA memory screening site?(Required)YesNoAlready a memory screening siteAge(Required)18-2425-3435-4445-5455-6465+Prefer not to answerGender(Required)Prefer not to answerManWomanOtherEthnicity(Required)American Indian/Alaska NativeAsianBlack/African AmericanHispanic/LatinoNative Hawaiian/Pacific IslanderWhitePrefer not to answerAre you interested in coming early or staying late to volunteer and help us provide a better experience for attendees?(Required) Sure, I'm interested in volunteering at 8:00 AM Sure, I'm interested in volunteering after the event until 1:30 PM Not at this time Δ Add to calendar Google Calendar iCalendar Outlook 365 Outlook Live
