UNLOCKING HOPE FOR ALZHEIMER'S DISEASE

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Training courses supported by: Global Grant (CG 2570241) of Rotary Foundation

Note: All applicants will be screened before acceptance. The organising committee reserves the right not to admit the applicant. Seats are limited. Terms & conditions apply.

Email *

Option 1

Clear selection

Name as per IC *

IC number *

Age *

Gender *

male

female

Handphone number *

Correspondence Address *

Please kindly tick one: *

Caregivers Workshop - 1 day (Certificate of Attendance)

Care Workers Course - 2 days (Assessment required for Certificate of Completion)

Language proficiency *

English

Bahasa Malaysia

Mandarin

If you are a caregiver, who do you care for *

father

mother

father-in-law

mother-in-law

sibling (brother / sister)

son / daughter

husband

wife

ADFM volunteers

How old is the person with dementia? *

If you are a care worker, where do you work? *

Are you looking at this course to progress in your career? *

Yes

Maybe

Have you attended any dementia training before? *

Yes

Maybe

To register for the workshop or course, please kindly register on this form. Commitment fee of RM100.00 is required. Please kindly make payment to: ALZHEIMER'S DISEASE FOUNDATION MALAYSIA
CIMB Account Number: 800 2293 277 *

Please kindly whatsapp receipt to: 010 219 8613 for tracking of your registration

Add remarks on receipt: Caregivers Workshop

For Care Workers Course, do not pay until we notify you, as selection criteria applies

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