Expression of Interest Form

Thank you for your interest in joining the Northern Beaches Dementia Advisory Group.

Please note that membership in the advisory group is only open to people living with dementia and their carers. 

The Northern Beaches Dementia Advisory Group will inform and work with the Northern Beaches Dementia Alliance  to create a community that is safe and supportive for people living with dementia. This will be achieved through education and awareness programs. 

We would like to invite passionate and pro-active community members to join us to implement a Dementia Friendly Community Project in the Northern Beaches. 

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* 1. Full Name 

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* 2. Which Suburb do you live in?

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* 3. Please provide your contact details below.

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* 4. Please select the statement that best describes you:

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* 5. How would you like to be involved? (tick all that apply)

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* 6. Do you have any other information that you would like us to know?

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