MADRC Speaker Request Form

MADRC Speaker Request Form
Thank you for reaching out to the Massachusetts Alzheimer’s Disease Research Center (MADRC). We have an extensive Speakers’ Bureau made up of faculty willing to give educational talks in Boston and surrounding communities about memory, aging and Alzheimer’s Disease.

Generally, we require a minimum of 15 attendees for your program and ask that you promote it widely.

PLEASE NOTE: It may take up to 2 weeks to receive a response and up to 3 months to book a program. Your request will be reviewed by our committee and a decision will be made based on other outreach events taking place at that time.

There is no fee for this service: however, donations to our organization can be made online here: http://bwhgiving.org/cart

Questions: Please call 617-278-0383
Select the type of program you are hosting from the list below:
Community Education

Health Fair TableMemory Research UpdatePanel Presentation (specify topic below)Workplace presentation (specify topic below)Other
Road Map Series Session: one hour educational programs for people concerned about aging and memory loss (choose one). To learn more about the Road Map Series, click the link below the titles.

Road Map to Dementia DiagnosisRoad Map to Research ParticipationRoad Map to CaregivingRoad Map to PreventionRoad Map to Behavior ManagementRoad Map to Social EngagementRoad Map to Acute Care Management
https://www.madrc.org/community/
Healthcare Professionals Education Program

Grand RoundsMemory Research UpdateRoad Map to Dementia DiagnosisPresenter for ConferenceOther
Requester Contact Information
Today's Date
Name
Email Address
Telephone Number
Your Organization & Address
Address of presentation location: street, city/town, zip code
What type of presentation are you seeking?

VirtualIn PersonHybrid
Select 3 potential dates and times for this program:

MonthDayYear
Date
Time

:HourMinutesAM/PM Option
Date

MonthDayYear
Date
Time

:HourMinutesAM/PM Option
Date

MonthDayYear
Date
Time

:HourMinutesAM/PM Option
Program Details (length of presentation, A/V needs, number of attendees)
Please provide any additional information that would be helpful for us to honor your request:
MADRC contact (if applicable)
We appreciate your interest in the MADRC Speakers’ Bureau.
Should be Empty: