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 Table Memory Research Update Panel Presentation (specify topic below) Workplace presentation (specify topic below)
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 Diagnosis Road Map to Research Participation Road Map to Caregiving Road Map to Prevention Road Map to Behavior Management Road Map to Social Engagement Road Map to Acute Care Management
https://www.madrc.org/community/
Healthcare Professionals Education Program

Grand Rounds Memory Research Update Road Map to Dementia Diagnosis Presenter for Conference
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?

Virtual In Person Hybrid
Select 3 potential dates and times for this program:

Month Day Year
Date
Time

: Hour Minutes AM/PM Option
Date

Month Day Year
Date
Time

: Hour Minutes AM/PM Option
Date

Month Day Year
Date
Time

: Hour Minutes AM/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.
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