Tell Us Why You Walk
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1. Tell Us Why You Walk
We are always interested in what draws people to Memory Walk and we are often touched by the stories of our participants. This is your opportunity to share with us why you walk. We'd love to share your story to inspire other walkers and donors, so please let us know if you'd like your story to be told.
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1
. How many years have you participated in Memory Walk?
How many years have you participated in Memory Walk?
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2
. Which Memory Walk are you currently participating in?
Which Memory Walk are you currently participating in?
Monterey County
San Francisco/Treasure Island
San Jose/Silicon Valley
Petaluma/Wine Country
Aptos/Santa Cruz
Chico/Bidwell Park
Sacramento/State Capitol
Carson City/State Capitol
Reno/Sparks
Fresno
3
. Why did you get involved in Memory Walk? (Check all that apply)
Why did you get involved in Memory Walk? (Check all that apply)
I have a family member with Alzheimer's disease
My company/organization has a team at the Memory Walk
I work in the Assisted Living/Long Term Care industry
A friend of mine has a loved one with Alzhiemer's and I walk with them
I'm a volunteer/staff person with the Alzheimer's Association
Other (please specify)
4
. Tell us why you walk. Include information about the person you are walking in honor/memory of, who walks with you, what you like best about the Memory Walk, any past fundraising success you have had.
Tell us why you walk. Include information about the person you are walking in honor/memory of, who walks with you, what you like best about the Memory Walk, any past fundraising success you have had.
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5
. Please provide any contact information you can.
Please provide any contact information you can.
Name:
Company:
Address:
Address 2:
City/Town:
State:
-- select state --
AL Alabama
AK Alaska
AS American Samoa
AZ Arizona
AR Arkansas
CA California
CO Colorado
CT Connecticut
DE Delaware
DC District of Columbia
FM Federated States of Micronesia
FL Florida
GA Georgia
GU Guam
HI Hawaii
ID Idaho
IL Illinois
IN Indiana
IA Iowa
KS Kansas
KY Kentucky
LA Louisiana
ME Maine
MH Marshall Islands
MD Maryland
MA Massachusetts
MI Michigan
MN Minnesota
MS Mississippi
MO Missouri
MT Montana
NE Nebraska
NV Nevada
NH New Hampshire
NJ New Jersey
NM New Mexico
NY New York
NC North Carolina
ND North Dakota
MP Northern Mariana Islands
OH Ohio
OK Oklahoma
OR Oregon
PW Palau
PA Pennsylvania
PR Puerto Rico
RI Rhode Island
SC South Carolina
SD South Dakota
TN Tennessee
TX Texas
UT Utah
VT Vermont
VI Virgin Islands
VA Virginia
WA Washington
WV West Virginia
WI Wisconsin
WY Wyoming
ZIP/Postal Code:
Country:
Email Address:
Phone Number:
6
. Do we have permission to share your story?
Do we have permission to share your story?
yes, feel free to share my story
maybe, please contact me first
no, not at this point
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