Alzheimer's
Foundation of America

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Register to Start an AFA on Campus Chapter

Register to Start an AFA on Campus Chapter

Thanks for your interest in starting an AFA on Campus chapter at your college/university! Please fill out the form below to submit your request. If you have any questions, please contact AFA’s Young Leadership Coordinator, Adam Cruz at 866-232-8484, ext. 122.

Name*
First Last
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Name of college/university that you are attending*
College/university mailing address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
What is your anticipated graduation year?*
What is your major?*
Which is the best way to reach you?*
- Phone
- Email

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Name*

First Last

Email*

Organization (if applicable)

Address*

Street Address City State ZIP Code

What encouraged you to sign up?

I'm a family caregiver

I'm a dementia care professional (i.e. doctor, nurse, social worker, home health aide)

I'm living with a dementia-related illness

I'm interested in learning more about AFA

Other

If other, please specify.

Alzheimer's
Foundation of America

Register to Start an AFA on Campus Chapter

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Alzheimer's Foundation of America

Register to Start an AFA on Campus Chapter

Contact Us

Alzheimer's
Foundation of America