ASiO - Share Your Story Questionnaire

Thank you for wanting to share your story and your experience with the Alzheimer Society.

The below questions will help you navigate how to tell your story. Please do not feel obligated to answer all the questions, however, the more detail in your response, the better!

By filling out this document, you are agreeing that the Alzheimer Society can utilize your story and any pictures you may supply us in our marketing materials such as social media, blog posts, etc.

Provide your information:
2. What is your connection to Alzheimer's disease and/or other dementias? (Select one of the available choices or enter a different value.)
   Please leave this field empty