Practitioner Members

First Name *

Last Name *

What rare or young onset dementia is most relevant to you?

Young onset Alzheimer’s disease (YOAD)

Frontotemporal dementia (FTD) including behavioural variant FTD (bvFTD)

Primary progressive aphasia (PPA) including progressive nonfluent aphasia (PNFA), semantic dementia (SD) and logogenic aphasia (LPA)

Lewy Body dementia (LBD)

Posterior cortical atrophy (PCA)

Familial Alzheimer’s disease (FAD)

Familial frontotemporal dementia (fFTD)

Other

What can we offer you as a practitioner member?

Direct support services for individuals and/or families you work with

Resources, information, and training on emerging evidence-informed practice

Opportunities to contribute to new learning and co-produce activities (i.e., awareness and advocacy initiatives, service evaluation and development, research)

(Please select all that apply)

What is your role as a practitioner?

Please choose the description that best matches your role

I am registered with a regulatory body

Yes

What type of organization do you work for?

Please choose the type that best describes where you work

What is the name of the organization?

Your Email Address *

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Confirm Your Email Address *

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Password *

Create Password

Confirm Password *

Confirm Password

Your Contact Telephone Number

Alternative Contact Telephone Number

Your Province

Work Postal Code

Which race category best describes you?

What is your age?

How did you find out about Rare Dementia Support Canada?

Member Consent

I understand that Rare Dementia Support Canada is collecting and holding information about me in order to provide support, information and resources to me, and to develop the service. I understand that I will receive information via email on support group meetings and activities; learning materials, resources and news on rare or young onset dementia; and research opportunities. I understand that I may receive a phone call from Rare Dementia Support Canada. I know that I can unsubscribe at any time.

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Thank you for your interest in becoming a member of Rare Dementia Support Canada!

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