Dementia Friends Wisconsin event request

Dementia Friends Event Request

Please complete this form when you have scheduled a Dementia Friends Information Session or Champion Training. You will need to complete this form for each session/training you provide.

Type of Event: Are you conducting an Information Session or a Champion training?*
Select one
Date of session/training (mm/dd/yyyy)*
Time of event*
Please include start and end time.
Name of event host*
Please include name of Master Trainer or Champion hosting this session or training.
E-mail address*
Please include email address of Master Trainer or Champion.
Event Audience
Please check all that apply.
Is your event open to the public?
If your event is open to the public, please indicate how you want people to register. Include details of who should be contacted and how any registration deadline.
Event location
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Name
This field is for validation purposes and should be left unchanged.