Demystifying Dementia Educational Sessions - Booking Form
Thank you for your interest in our Demystifying Dementia educational sessions. Please complete the booking form below and we will be in touch as soon as possible to confirm further details with you.
First Name
Last Name
Email Address
Contact Phone Number
GHA Resident Name (if applicable)
Please let us know which of the below upcoming sessions you would like to attend:
Friday, 17 May (12.00-3.00pm)
Thursday, 23 May (6.00-8.30pm)
Friday, 28 June (12.00-3.00pm)
Thursday, 4 July (6.00-8.30pm)
Friday, 26 July (12.00-3.00pm)
Will anyone else be attending with you?
Yes
No
If yes, how many people will be joining you and can you please share their names?
Please let us know if you have any dietary requirements:
How did you hear about our Demystifying Dementia sessions?
Website
Email from GHA
Word of mouth
Previously attended one of the sessions
Other (please specify below:)
Please share with us what you are hoping to gain or take away from the session:
Other questions or comments?