Registration form for the recognition process for Dementia Friendly Communities in Northern Ireland

We ask for your details in order to contact you, keep you up-to-date and send further information.

To find out more about how we use your personal information, please read our supporter privacy statement.

Please tell us the name of the person filling out this form. (required)

Please provide your email address (required)

Please tell us the name of the person who is taking responsibility for meeting the requirements of the recognition process if different to above. (required)

Please provide their email address if different to above (required)

Please give the approximate size of the population for the community becoming dementia friendly (required)

Communities will be required to have publicly available information on their actions to become dementia friendly. Please tell us where you intend to hold this information, for example on the local dementia action alliance site or on a page of another website? (required)

Please tell us how you are intending to engage with people with dementia living in your community in your plans to become dementia friendly? (required)

Please tell us how you are intending to use the 'working towards becoming dementia friendly' symbol (required)

Where is your community based? (required)

Registration form for the recognition process for Dementia Friendly Communities in Northern Ireland

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