Alzheimer Society of Toronto

Advisory Committee

Are you living with dementia or caring for someone with dementia? Have you used our programs and services in the past? Do you want to help develop a guiding vision that will inform the work we do at the Alzheimer Society Toronto (AST)? If so, you are invited to join the Alzheimer Society Toronto (AST) Advisory Committee. The group meets on a quarterly basis where you will get the opportunity to provide your feedback, thoughts and reccomendations that will enhance the organization and promote a dementia-friendly community. There’s also the opportunity to connect with other individuals experiencing similar life journeys.

Contact information:


*	First Name: Required
*	Last Name: Required
*	Email: Required
*	Street 1: Required
	Street 2:
*	City: Required
*	Province / State: Required
*	Postal / ZIP Code: Required
*	Phone Number: Required
	If you respond and have not already registered, you will receive periodic updates and communications from Alzheimer Society.

*

Question - Required - Help us serve you better, tell us what is the relationship you have with the person living with dementia.
Please make between 1 and 4 selections from the choices below.

	I am living with dementia
	Spouse/Partner
	Mother
	Father
	Sibling
	Grandparent
	Other

*

Question - Required - When did you start receiving services from AST? What supports have you received?

(Maximum response 255 chars, approx. 5 rows of text)

*

Question - Required - What led you to want to take part in the Advisory Committee

(Maximum response 255 chars, approx. 5 rows of text)

*

Question - Required - What format would you prefer to participate in the Advisory Committee?

Virtual via Zoom

In person

Question - Not Required - If you chose in person, which is your preferred location?

20 Eglinton Avenue West (Main office)

2658 Eglinton East (Mid-Scarborough Hub)

Not applicable - I chose virtual

*

Question - Required - What is your preferred meeting time?

11:00 am - 1:00 pm

1:00 pm - 3:00 pm

None of these times work for me

Question - Not Required - What other considerations should we be aware of?

(Maximum response 255 chars, approx. 5 rows of text)

AST - Advisory Committee