Survey - Sign the Petition to End Alzheimer's Disease

Sign the Petition to End Alzheimer's Disease

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1.

Question - Not Required - Please share your thoughts on the National Plan to Address Alzheimer's Disease:

*2.

Question - Required - I give permission to post my suggestions on the BrightFocus Foundation website or in printed informational materials.

3.

Contact Information

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Name:

Title	First Required	Last Required

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Email: Required

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Street 1: Required

Street 2:

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City/State/ZIP:

City Required	State Required	ZIP Required

Phone Number:

Yes, I would like to receive e-mail from the American Health Assistance Foundation (AHAF) and/or its programs. (Please note: If you uncheck this box, you will not receive any of our research alerts, advocacy updates, and other valuable resources).

Email Format:

Remember me.

4.

Question - Not Required - Yes, I would like to receive e-mail communications from the BrightFocus Foundation and/or its programs:

	Advocacy: Alzheimer's Disease
	Advocacy: Vision
	Alzheimer's Medical and Research Alerts
	Glaucoma Medical and Research Alerts
	Macular Degeneration Medical and Research Alerts
	The BrightFocus Foundation