Signup to become an Alzheimer Champion

Name

Male Female

Age

Address

City

State Zip

Phone

Email

Please mark the most appropriate connection you have to Alzheimer's disease:

I have received a diagnosis of Alzheimer's disease.

I have/had a family member with Alzheimer's disease. If so, I am a caregiver to this person.

I am currently a professional caregiver for someone with Alzheimer's disease.

I have a friend with Alzheimer's disease.

I have a professional interest in Alzheimer's disease.

I do not know anyone with Alzheimer's disease.

I plan to take an active role in the following areas:

Advocate — Be the voice of change!

How would you like to ADVOCATE?
Advocacy Team	Make personal visits and phone calls to legislators when specific action is needed.
Missouri Memory Day	Join advocates from all across Missouri for our annual bus trip to Jefferson City to meet with our state legislators and inform them of the critical funding needs.
Planning Committee	Help plan the local advocacy rally and/or Memory Day logistics.

Fundraise — Participate in a Chapter-sponsored fundraiser or create your own event.

How would you like to FUNDRAISE?
Memory Walk	Walk individually or start a team for one of the Chapter’s six community walks.
Other Chapter Special Events	Participate as an ALZ Star athlete, Blondes vs. Brunettes flag football player, Texas Hold’em Player, or Memories in the Making Art Auction attendee.
Third Party Fundraiser	Coordinate your own event with proceeds benefiting the Heart of America Chapter.

Donate — Contribute to creating a world without Alzheimer’s.

How would you like to DONATE?
Planned Gift	Support our mission with a planned financial gift while also meeting your overall estate, financial and tax goals.
Stock Gift	Donate securities to support those affected by Alzheimer’s and receive tax benefits.
Workplace Giving	Designate your gift through the corporate United Way Donor Choice program, or maximize your gift by capitalizing on your company’s matching gifts program.

Volunteer — Help change the course of Alzheimer’s disease!

How would you like to VOLUNTEER?
Community Outreach	Represent the Chapter at community or corporate health fairs, help facilitate a weekly art program for those with dementia or act as monthly Project Lifesaver monitor.
Events	Assist the Chapter staff with various fundraising event-day activities.
Office Assistant	Help as needed with office duties including assembling/preparing mailings, data entry and library assistance.