Virginia's ALZHEIMER'S COMMISSION

ALZPOSSIBLE INITIATIVE 

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FIND A SPEAKER FOR YOUR EVENT!

Looking for a keynote speaker or trainer for your next event?  AlzPossible can help you - simply tell us what you are looking for!  The more specific and complete the information you provide us, the better we will assist you.

I am interested in receiving the following information:

First name:*

 

Last Name:*

 

Organization:*

Address:*

City:*

State:*

Country:*

Zip:*  

Phone:*

 

Fax: 

E-mail:*

 

Web Site:

a.

My Meeting or Event is:

 

in the next 3 monthswithin the next year    

on this date(s):  

b.

Type of Meeting or Event: (e.g., training seminar, symposium, association conference, president's club, banquet, etc.) 

Type: 

c.

Topics to be addressed: (e.g. caregiving, research, etc. – be as specific as possible.)

Topics: 

d.

Location of this presentation (city, state, country)

e.

Type of audience (caregivers, healthcare professionals, etc.)

f.

Anticipated number of participants

g.

I am looking for:

 

Keynote Speaker(s)

Seminar/Workshop(s)

Other (please describe)

h.

Additional Information:
Please add additional information about your meeting or audience that might be helpful to us in assisting you to select the perfect presenter for your meeting or event.

 

i.

Optional Information:

How did you find us? 

 

Newsletter     Word-of-mouth    

Advertisement -- Where? 

 

Link from another web site -- Which One? 

 

Search Engine -- Which One? 

 

Thank you for allowing us to serve you.