Surrey Event Registration Form

I'm Still Me: Educational Session

Join us for an informative and engaging educational session as part of the I'm Still Me project. This session is focused on reducing stigma associated with dementia by increasing awareness and understanding of dementia, deconstructing prejudice, reducing barriers and fostering more dementia inclusive communities.

Please be advised that this is the registration form for the in-person event in Surrey on January 25th, 2024 from 10:00 AM to 2:00 PM.

Question Title

* 1. Contact Information

First name *

Last Name

Email Address *

Question Title

* 2. What best describes you?

Person living with dementia

Caregiver of someone living with dementia

Dementia Advocate

Community member interested in learning about dementia

Representative from a community organization

Healthcare professional (e.g., Doctor, Nurse, Health Care Assistant)

Other (please specify)

Question Title

* 3. How did you hear about the event?

Word of mouth (e.g., friend or family, coworker or colleague)

Social media platform (e.g., Facebook, Twitter, Instagram)

Email newsletter, poster, flyer

Through the organizer's website (i.e., Brella Community Services Society or I'm Still Me)

Other (please specify)

Question Title

* 4. Are you interested in receiving additional information about dementia resources and support

Yes

Surrey Event Registration Form

I'm Still Me: Educational Session

Question Title

* 1. Contact Information

Question Title

* 2. What best describes you?

Question Title

* 3. How did you hear about the event?

Question Title

* 4. Are you interested in receiving additional information about dementia resources and support

Question Title

* 5. Do you have any specific questions or topics related to dementia that you would like the event (or upcoming events) to address?

Question Title