Register for: Brain Health 101- LGBTQ+ Thrive with Pride Webinar Series- Wednesday February 8, 4:00-5:00 pm PST

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Kick your New Year’s Resolutions into high gear with our tips to take care of our bodies and brains. It’s never too early or too late to incorporate brain-healthy habits - and some of them might surprise you!

All demographic data is kept confidential and is collected to help us with our aim to improve health equity for all communities.

A Zoom link will be sent shortly after you complete this form. If you have any questions you can reach out to Katya Samodurov on (415)-463-8504.

Email *

Name *

Zip Code *

Age

What is your current gender identity? (choose all that apply):
*

Male

Female

Trans Man

Trans Woman

Non-binary / Gender fluid

Prefer not to disclose

Other:

Required

What is your current sexual orientation? (choose all that apply) *

Gay

Lesbian

Bisexual

Pansexual

Queer

Asexual

Straight (Heterosexual)

Questioning or unsure

Prefer not to dislose

Other:

Required

Which race or ethnicity best describes you?

American Indian or Alaskan Native

Asian / Pacific Islander

Black or African American

Hispanic / Latinx

White / Caucasian

Multiple ethnicity

Prefer not to disclose

Other:

Clear selection

Any other questions or comments

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Alzheimer's Association. Report Abuse

Forms