Newsletter Delivery Request Form

In an effort to communicate with you in the most efficient and effective manner, we are attempting to put as much information online as possible, given the requests of many of our readers.

In the future we will only provide printed copies of this newsletter for those who request it by returning this form. For those who prefer to read online, the newsletter can be accessed in a PDF format on this website

Please tell us by filling out this form how you would prefer to receive newsletter information.

Thank you for your quick response.

Check your distribution choice to receive the newsletter:

	Traditional printed newsletter (via US mail)
	Electronic newsletter (via pdf on website)

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	Individual with dementia
	Family member of someone with dementia
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In between newsletter issues, there may be smaller, email news flashes we can send. Would you be interested in receiving these email news flashes?

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