Conference Registration Form

Understanding Dementia: A Caregiver's Perspective

This FREE one-day conference, hosted by Mountain Empire Older Citizens, is dedicated to empowering, educating, and connecting caregivers who support individuals living with dementia. Whether you're a family member, professional caregiver, or non-professional caregiver, this event offers resources, expert-led sessions, and a supportive environment to enhance your caregiving journey.

Why Attend?
- Gain actionable strategies and insights
- Connect with a supportive community
- Access tools and resources for daily caregiving
- Leave feeling informed, empowered, and less alone

The conference will be held on October 14th, 2025, at Heritage Church of God in Big Stone Gap, VA from 10 am - 3 pm. Please make plans to attend the entire day.

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* 1. Caregiver Name

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* 2. Mailing Address

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* 3. Email

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* 4. Phone number

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* 5. Do you have dietary restrictions? (if yes, please specify)

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* 6. Do you require any accessibility accommodations? (if yes, please specify)

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* 7. Do you require transportation to and/or from the event?

Yes

Unsure

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* 8. How did you hear about the event?

Facebook

Newspaper

MEOC Website

Friend or Family

Other (please specify)

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* 9. Do you grant permission for MEOC to use event photographs that may contain your image in future publications?

Yes

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* 10. Would you like receive future mailings from MEOC regarding dementia and/or caregiver information?

Yes