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Volunteer Application

The Heart of America Chapter’s ability to reach the more than 200,000 families in our 66 county service area depends greatly on the work of our dedicated volunteers. If you would like to join us in the fight against Alzheimer’s disease, please complete the following information. Thank you for becoming involved!

Name:
Mailing Address:
City:
State:
Zip:
Daytime Phone:
Evening Phone:
Email Address:
FAX:
Occupation:
Employer:

Why are you interested in volunteering for the Alzheimer’s Association at this time?

When are you available to volunteer:
(please check all that apply)

Weekdays		Weekends
Morning		Morning
Afternoons		Afternoons
Evenings		Evenings

Check all of the opportunities below in which you are interested in becoming involved. Click here for an explanation of our volunteer opportunities.
(please check all that apply)

Education/Programs
	Health Fairs
	Volunteer Artist for Memory Room and/or Memories in the Making
	Support Group Co-Leader
	Speakers Bureau
	Public Policy/Advocacy
	Special Educational Projects

Special Events/Office Assistance
	Memory Walk
	Memory Walk Planning Committee
	Memories in the Making Auction - April
	Special Office Projects
	Office Assistant

Thank you again for joining us in the fight against Alzheimer’s disease. If you have any questions, please contact us at 913-831-3888.

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»	March 30 - The Role of Activities in Cultural Change This workshop discusses the philosophy behind activities and offers numerous examples of ways to incorporate these activities in day to day life. 9:00 a.m. - 4:00 p.m. at St. Joseph Hospital. Call 913-831-3888 or for details.

»	April 5 - April 26: Redefining Me in Topeka, KS A 4-part discussion about the process of diagnosis, risk factors, symptoms revealed in the disease and current treatments. Call 785-271-1844 or for details.

»	April 14 - Alzheimer's and Aging with Intellectual Disabilities An overview of how Alzheimer's manifests in persons experiencing intellectual disabilities such as Down's Syndrome. Call 785-271-1844 or for details.