Alzheimer Society of Toronto

Non-Impact Aerobics (NIA) online.

THURSDAYS from 11:00 a.m. – 12:00 p.m.

For more information, please contact Kristin Bartlett at kbartlett@alz.to or 416-847-6339

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
*	Date of Birth: Required	Date of Birth:
	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, please identify if you are a:

Person living with Dementia

Person living with Early Stage Dementia

Person living with Young Onset Dementia

Person experiencing symptoms of dementia or MCI (mild cognitive impairment)

I am a family member/care partner

I am a paid caregiver

Question - Not Required - How many people are going to attend this event including you?

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

*

Question - Required - Can you please type in your preferred gender? (If you prefer not to disclose, please write "Prefer not to answer")

*

Question - Required - Please provide us with an emergency contact, and identify the relationship to the participant.

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

AST - Non-Impact Aerobics (Nia) 2023