Jump to content

Dementia Advocate Registration Form


Dementia Advocate Registration Form


  • If you have indicated that you would like to help by sharing your story with the media this information will assist us in determining the most appropriate person to contact when a consumer is required. Some of this information may be provided to media outlets as background material for the item. Identifying and contact details will not be provided without your permission.


    This information will be stored on the Alzheimer's WA database. It will be used solely for activities of Alzheimer's WA and disclosed to a third party only when you have given us permission to do so. All information collected remains confidential, is securely stored and is only accessible by appropriate Alzheimer's WA staff. For a full copy of the Alzheimer's WA Privacy Policy please email dfc@alzheimerswa.org.au or call 1300 66 77 88.
  • This field is for validation purposes and should be left unchanged.

Stay in touch

Become a Member

Stay in touch

Sign up for our enewsletter to find out the latest news, the difference we’re making, and most importantly, how you can help.

Subscribe to Our Newsletter

  • This field is for validation purposes and should be left unchanged.