« All Events Educating America Tour: Boston, MA June 12 @ 10:00 am – 1:00 pm EDT Wyndham Boston Beacon Hill 5 Blossom Street Boston, MA 02114 (Click for downloadable PDF) Add to calendar Google Calendar iCalendar Outlook 365 Outlook Live 2024 Educating America Tour: MA Registration Form Name(Required) First Last Email(Required) Phone(Required)Street Address City, 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.) Organization (if applicable) Would your organization/agency like to become an AFA member?YesNoAlready a memberWould you like to get a free memory screening?YesNoWould your organization like to become an AFA memory screening site?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? 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 Related
« All Events Educating America Tour: Boston, MA June 12 @ 10:00 am – 1:00 pm EDT Wyndham Boston Beacon Hill 5 Blossom Street Boston, MA 02114 (Click for downloadable PDF) Add to calendar Google Calendar iCalendar Outlook 365 Outlook Live 2024 Educating America Tour: MA Registration Form Name(Required) First Last Email(Required) Phone(Required)Street Address City, 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.) Organization (if applicable) Would your organization/agency like to become an AFA member?YesNoAlready a memberWould you like to get a free memory screening?YesNoWould your organization like to become an AFA memory screening site?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? 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 Related
