30th Annual Alzheimer Day Attendee Registration

30th Annual Alzheimer Day Attendee Registration

Join us for our 30th Annual Alzheimer Day on Friday, May 3, 2024 in-person at the Feinberg Pavilion Conference Center. Northwestern Alzheimer Day was established to showcase Alzheimer’s-related dementia and aging research conducted throughout Northwestern and to bring this information to the community. Attendees will have the opportunity to connect with community members and researchers over lunch and through the presentation of research posters.

There is no charge to attend Alzheimer Day.

Please note, this year's event will only be offered in-person. An event recording will be available on our website in the weeks following the event for those who cannot attend in-person. CEU credit will only be offered to in-person attendees.

Space for this event is limited. If you find that you are unable to attend, please email Mesulam-Center@northwestern.edu to cancel your registration so someone else may be able to attend in your place

For any questions, please contact our center via email Mesulam-Center@northwestern.edu, or via phone 312-908-9339.

In order to collect important demographic information, please complete the questions below.

Name Name First Last
E-mail
Postal/Zip Code
You can use this form to register up to 3 in-person attendees. How many people will you be registering today?

You can use this form to register up to 3 in-person attendees. How many people will you be registering today? 1 2 3
Are you or someone you are caring for a patient at the Northwestern Neurobehavior and Memory Clinic?

Are you or someone you are caring for a patient at the Northwestern Neurobehavior and Memory Clinic? Yes No
Are you or someone you are caring for a research participant in the Mesulam Center?

Are you or someone you are caring for a research participant in the Mesulam Center? Yes No
I am a (check all that apply):

I am a (check all that apply): Person with Alzheimer's or related disorder Research participant Family or friend of person with dementia Interested member of the community Researcher/scientist Health care or social service professional Physician Alzheimer Day Sponsor Alzheimer Day Poster Presenter Mesulam Center Faculty, Staff, or Student Prefer not to answer Other Other
Please indicate the Company/Organization you are representing
Race (Select All that Apply)

Race (Select All that Apply) American Indian/Alaska Native Asian Black/African American Native Hawaiian or other Pacific Islander White Prefer not to answer Other Other
Ethnicity:

Ethnicity: Hispanic/Latino Not Hispanic/Latino Prefer not to answer
Gender:

Gender: Male Female Prefer not to answer Other Other
Would you be interested in receiving announcements from the Mesulam Center?

Would you be interested in receiving announcements from the Mesulam Center? Yes, please send announcements to my e-mail address. No, I am not interested in receiving announcements.
How many years have you attended Alzheimer Day?
How did you hear about this event? (check all that apply)

How did you hear about this event? (check all that apply) Internet Mailed invitation E-mailed invitation Word of mouth Other - If other, please specify: Other - If other, please specify:
Continuing Education: The Northwestern University Feinberg School of Medicine will offer 3 CEUs to Social Workers for attending Alzheimer Day. Will you be requesting CEUs for attending this event?

Continuing Education: The Northwestern University Feinberg School of Medicine will offer 3 CEUs to Social Workers for attending Alzheimer Day. Will you be requesting CEUs for attending this event? Yes No
Would you like to register a second person?

Would you like to register a second person? Yes No
Second Attendee Information

Please complete all of the below fields for the second person you wish to register.
Name Name First Last
E-mail
I am a (check all that apply):

I am a (check all that apply): Person with Alzheimer's or related disorder Research participant Family or friend of person with dementia Interested member of the community Researcher/scientist Health care or social service professional Physician Alzheimer Day Sponsor Alzheimer Day Poster Presenter Mesulam Center Faculty, Staff, or Student Prefer not to answer Other Other
Race (Select All that Apply)

Race (Select All that Apply) American Indian/Alaska Native Asian Black/African American Native Hawaiian or other Pacific Islander White Prefer not to answer Other Other
Ethnicity:

Ethnicity: Hispanic/Latino Not Hispanic/Latino Prefer not to answer
Gender:

Gender: Male Female Prefer not to answer Other Other
Would you be interested in receiving announcements from the Mesulam Center?

Would you be interested in receiving announcements from the Mesulam Center? Yes, please send announcements to my e-mail address. No, I am not interested in receiving announcements.
How many years have you attended Alzheimer Day?
Continuing Education: The Northwestern University Feinberg School of Medicine will offer 3 CEUs to Social Workers for attending Alzheimer Day. Will you be requesting CEUs for attending this event?

Continuing Education: The Northwestern University Feinberg School of Medicine will offer 3 CEUs to Social Workers for attending Alzheimer Day. Will you be requesting CEUs for attending this event? Yes No
Would you like to register a third person?

Would you like to register a third person? Yes No
Third Attendee Information

Please complete the information below for the third attendee you would like to register.
Name Name First Last
E-mail
I am a (check all that apply):

I am a (check all that apply): Person with Alzheimer's or related disorder Research participant Family or friend of person with dementia Interested member of the community Researcher/scientist Health care or social service professional Physician Alzheimer Day Sponsor Alzheimer Day Poster Presenter Mesulam Center Faculty, Staff, or Student Prefer not to answer Other Other
Race (Select All that Apply)

Race (Select All that Apply) American Indian/Alaska Native Asian Black/African American Native Hawaiian or other Pacific Islander White Prefer not to answer Other Other
Ethnicity:

Ethnicity: Hispanic/Latino Not Hispanic/Latino Prefer not to answer
Gender:

Gender: Male Female Prefer not to answer Other Other
Would you be interested in receiving announcements from the Mesulam Center?

Would you be interested in receiving announcements from the Mesulam Center? Yes, please send announcements to my e-mail address. No, I am not interested in receiving announcements.
How many years have you attended Alzheimer Day?
Continuing Education: The Northwestern University Feinberg School of Medicine will offer 3 CEUs to Social Workers for attending Alzheimer Day. Will you be requesting CEUs for attending this event?

Continuing Education: The Northwestern University Feinberg School of Medicine will offer 3 CEUs to Social Workers for attending Alzheimer Day. Will you be requesting CEUs for attending this event? Yes No