Join Alzheimer's Society's Councillor Network

Thank you for your interest in the Alzheimer's Society Councillor Network.

Please complete this short form to join our network.

First name (required)

Surname (required)

Nation (required)

Which political party in England do you represent? (required)

Which political party in Northern Ireland do you represent? (required)

Which political party in Wales do you represent? (required)

Council type For England (required)

Council type for Northern Ireland (required)

Council type for Wales (required)

Name of council/local authority you represent (required)

Work email address (required)

Confirm email (required)

How did you hear about the Councillor Network? (required)

We would be interested to know more about what you would like to gain from the Councillor Network through this short questionnaire.

Useful links