Online NSCE Registration

Online Dementia Education Series: Next Steps & Care Essentials

This information will be used in the event a Dementia Education Series: Next Steps & Care Essentials session has to be rescheduled or cancelled. Please complete this form once for each person who will attend the learning series.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Cell Phone
Home Phone
E-mail*
example@example.com
Health Card Number
Health Card Version
The Alzheimer Society Niagara Region hopes to understand better the population we support. To help us, please answer the following demographic questions.
Language Spoken at Home
Mother Tongue
Gender
Racial or Ethnic Group
Birthdate

MonthDayYear
Date
Select the date of the session you are registering for. All sessions below will be held online via Zoom.*

October 21, 23, 28 & 30, 2024 (1:30 - 3:30 pm - Online)November 26, 28, December 3, 5, 2024 (6:30 pm - 8:30 pm - Online)February 11, 13, 18 & 20, 2025 (6:30 - 8:30 pm - Online)
Comments:
Enter the word as it's shown*
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Online Dementia Education Series: Next Steps & Care Essentials