2017 Georgia Awareness Day Registration Form

 

Turn Georgia Purple for Alzheimer's

Awareness Day at the Capitol: Friday, February 3, 2017

It appears that the Legislature will not be in Session on that day--however, we are still on!  We will go as usual, have our morning program, meet with any legislators who may be at the Capitol that day with whom we can get an appointment (and if not, we'll meet with their staff--who often can influence their boss to support legislation--especially if they have a personal connection to the disease), have our morning program and update on where our legislation is, our lunch program will bill sponsors and key department heads, complete our meeting report forms, then have a safe trip home following a successful day!

Advocates will speak with our State Senators and State Representatives (or their staff) about the needs of those living with Alzheimer's disease or a related dementia and their families and advocate for 1 Legislative Priority and 3 Budget Priorities. To read more details about each issue, please visit our Advocacy page


Legislative Issue:

  • Uniform Power of Attorney Act

Budget Issues:

  • Two GBI Position to combat Elder Abuse - budget request of $334,676
  • Adult Abuse Negelct & Exploitation Prosecutor - budget request of $144,362
  • Home & Community Based Services (HCBS) Funding - $10 Million Non-Medicaid HCBS                                

 Awareness Day Information:

  • Advocate Check-In at 8:30 a.m. at Central Presbyterian Church, 201 Washington Street SW, Atlanta, 30303
  • Lunch will be provided
  • Awareness Day concludes at 3:00 p.m.
  • There is no cost to attend, however, registration is required.
  • Online registration deadline: Tuesday, January 31. Walk-on registrations will still be accepted.
  • 20 Awareness Day Trainings will be held across the state—at least two in every Chapter Service Area.  Please plan to attend one of these trainings to learn more about our platform, our issues, and how to use our collateral and fact sheets in speaking with your legislators.  If you are unable to attend an in-person training, we will post the platform, collateral, fact sheets, and agenda on our Chapter Advocacy web page on Friday, January 27, 5:00 p.m.  We will not provide a webinar this year.
  • This form allows you to register two individuals.  If you wish to register one or more additional people, please call 1-800-272-3900. 
  • Please DO NOT attempt to register a third person on this same form, as it could overwrite and corrupt your information and you will not be registered.
  • Space is limited to 300 people, based upon the Fire Code at the church--so registration is first-come, first-served.
1. Please provide the following--we need your address in order to look up who your state senator and representative are; we need your phone number in case we need to call you back to the church if you are at the Capitol and your legislator joins us there:

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City/State/ZIP:

 

    

 

 

 

What's this?

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Question - Not Required - Please check all of the following that apply:

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Question - Not Required - If I am a person with Alzheimer's or a related dementia, my date of diagnosis was:




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Question - Required - Please indicate your interest in the training below:




















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Question - Required - We are providing a newly-designed t-shirt for Awareness Day this year. We ask that all attendees wear their T-shirt on Awareness Day. In order to have your t-shirt available for you to pick up when you attend an Awareness Day Training in your Chapter Service area, please provide us your preferred t-shirt size.






 

 

If you wish to register additional attendees at this time, please provide the information below for up to 2 individuals.  If you wish to register more than two additional individuals, please call your Regional Office to complete additional registrations at 1-800-272-3900.

 

 

Additional Attendee #1

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Question - Not Required - Please check all of the following that apply for Additional Attendee #1:

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Question - Not Required - [Additional Attendee #1] Please indicate your interest in the training below:




















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Question - Not Required - [Additional Attendee #1] We are providing a newly-designed t-shirt for Awareness Day this year. We ask that all attendees wear their T-shirt on Awareness Day. In order to have your t-shirt available for you to pick up when you attend an Awareness Day Training in your Chapter Service area, please provide us your preferred t-shirt size.






 

 

Additional attendee #2

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Question - Not Required - Please check all of the following that apply for Additional Attendee #2:

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Question - Not Required - [Additional Attendee #2] Please indicate your interest in the training below:




















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Question - Not Required - [Additional Attendee #2] We are providing a newly-designed t-shirt for Awareness Day this year. We ask that all attendees wear their T-shirt on Awareness Day. In order to have your t-shirt available for you to pick up when you attend an Awareness Day Training in your Chapter Service area, please provide us your preferred t-shirt size.






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