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Membership Application Form - Alzheimers Jamaica






    HomeOffice




    NoYes


    Present CarerPast CarerConcerned relative/friendProfessionalInterestedWant info on legacies and bequests

    NoYes

    Annual (3600)6 months (1800)3 months (900)One month (300)Other (specify monies paid)

    NoYes

    I consent to Alzheimer's Jamaica (AlzJA) collecting personal data about me in this Membership Form for approval and administrative purposes. I also consent to the possibility that my membership status will not be approved and my fee is non-refundable, whether or not my membership is approved.