If you are interested in becoming an advocate, and want to learn more about how you can make a difference, please print this page, fill out the information below and return it to the address listed at the bottom of this page. Any information you share with us will be kept completely confidential.
Your relationship to the person with Alzheimer's disease:
Are you the primary caregiver?
Do you live with the person with Alzheimer's disease?
Have you used any of the following services?
__Adult Day Care
__Long Term Care Facility (Nursing Home)
With help and support from the Alzheimer's Association, I am willing to:
__Contact my state or federal representatives
__Visit my legislators with a group of advocates
__Testify about my experiences to legislators
__Tell my experiences to the media
__Share my story with members of the Alzheimer's Association
Please mail this form to:
196 Princeton-Hightstown Road, Bldg. 2, Suite 11
Princeton Junction, New Jersey 08550
Or fax to: 609.275.1182