Young Professionals Against Alzheimer's Membership Application
We are the Generation that will #ENDALZ

Who We Are and What We Do
The Young Professionals against Alzheimer’s Southeast Florida are dedicated professionals (age 18-40) who know the realities of Alzheimer’s all too well. They are fighting to End Alzheimer’s by challenging the way we understand the disease, bringing awareness to Southeast Florida, advocating for legislation that helps families and individuals living with Alzheimer’s disease on a local, state and federal level and raising funds to support families and cutting edge research that is occurring right here in Southeast Florida.
Member Responsibilities
1) Participate in Young Professionals Events (socials, Walk to End Alzheimer’s, workshops, etc.)
2) Be an Ambassador for the Young Professionals group and the Alzheimer’s Association.
3) Be a member in good standing
4) Recruit potential Young Professionals from within your personal and professional networks.
5) Participate in one of a few ways
a) Attend two Young Professionals Event per year
b) Serve on a Committee for a one year term
c) Commit to working on one project within committee during one year term.
Name *
First and last name
Email *
Phone number *
Address *
City, State, Zip *
Birthday *
Current Employer *
Region *
Committee Interest *
Are you interested in a leadership on a committee or the Executive Board?
In consideration of being allowed to participate in Alzheimer’s Association, Southeast Florida Chapter 
events/activities, I hereby expressly assume all risks of personal injury, death or property loss arising in 
any way out of my participation. I represent that I am physically fit and able to participate as a Volunteer. I 
hereby release and agree not to sue Alzheimer’s Association, its chapters, their respective officers, 
directors, volunteers, employees, sponsors and agents, from or in connection with any and all liability and 
claims arising out of my participation. I grant full permission to the Alzheimer’s Association to use and 
publish my name and image as a participant in photographs, video or other recordings.
Do you accept these terms?
Never submit passwords through Google Forms.
This form was created inside of Alzheimer's Association. - Terms of Service - Additional Terms