Alzheimer's Association Junior Board Membership Application
Thank you for your interest in the Alzheimer's Association, Greater Illinois Chapter Junior Board!

We induct Associate members twice a year, in June and December. To be considered for membership, please complete the application form below. As we near induction time, we will reach out to you to begin the new member orientation process. In the meantime, we ask that prospective Associate members try to attend at least one of our fundraisers, volunteer days, or advocacy events, prior to joining. You can find these opportunities listed on our website at www.alzillinoisjuniorboard.org. This will give you a chance to meet some of the current members and learn more about the Board. We also encourage you to follow us on Facebook, Instagram, and Twitter at @alziljrboard for more information and to stay connected.

If you have any questions, please contact our Vice President of Membership, Doug Adolph at membership@alzillinoisjuniorboard.org.

Member Details
First Name
Your answer
Last Name
Your answer
Home Address
Your answer
City
Your answer
State
Your answer
Zipcode
Your answer
Mobile Phone
Your answer
Email Address
Your answer
Birthdate
MM
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DD
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YYYY
Were you referred by a current Junior Board member? If so, please list their name:
Your answer
Employment Information
Current Place of Employment
Your answer
Position/Title
Your answer
Work City
Your answer
Business Email
Your answer
Does your company have a charity match program?
Does your company have a volunteer program?
About You
Have you previously attended a Junior Board or Alzheimer's Association function? If so, which one(s)?
Your answer
Why do you want to serve on the Alzheimer's Association Junior Board? What do you hope to gain?
Your answer
What do you think is your greatest asset(s) that would be valuable to the Junior Board?
Your answer
Are you currently a member of any other boards? If so, which one(s)?
Your answer
What is your closest connection to the cause?
Tell us about yourself and why you want to end Alzheimer's and related dementias (to be shared on Junior Board's social media and/or website)
Your answer
Share link to Google Drive or Dropbox photo of you or you and your loved one (to be shared on Junior Board's social media and/or website)
Your answer
Volunteer Agreement
Members of the Junior Board must register as volunteers of the Alzheimer's Association by completing the following
Please take a moment to fill out an Alzheimer's Association's volunteer profile at https://www.alzheimers-illinois.org/volunteer/volunteerProfile.asp so we may track your involvement as a member
Required
I VOLUNTARILY AGREE to accept and assume all responsibility and risk arising from my participation in activities with the Association. My participation in these activities is purely voluntary. I also understand and acknowledge that no insurance benefits, medical or otherwise, will be provided to me by the Alzheimer's Association during these activities or as a result of my participation in the activities. I agree that by volunteering for any activities which result in my driving a vehicle, I am certifying that I have a valid driver’s license and required insurance coverage. I VOLUNTARILY RELEASE the Alzheimer's Association from any and all liability, claims, causes or rights of action that arise out of or are in any way connected with my participation in these activities, including, but not limited to any and all negligence, fault, or strict liability of the Alzheimer's Association for any and all injury and damage to myself or to my property.
Required
Thank You!
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