IA2 AIAN Healthy Brain Website Talking Circle Registration

Registration Page

October 26, 2021

1 pm - 2:30pm EST

For any questions contact maryann@iasquare.org

Question Title

* 1. Contact Information

Name *

Organization

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

Question Title

* 2. I confirm that my mailing and email address are accurate for me to receive a Walmart gift card.

Yes! My mailing address and email address are accurate.

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* 3. Tribal Affiliation (if any)

Question Title

* 4. What website(s) do you currently use to find information about brain health, dementia, Alzheimer's or memory issues?

We will be sending an email prior to the session with access information.

Please share this information with friends.

We look forward to hearing from you!