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Please fill in the form below to register your interest in attending one of our 'Dementia - Friends and Family' sessions. We will be in touch with you to arrange a session shortly. Required items indicated with *.
Name:*
Email Address:*
Address:*
Postcode:*
Phone Number:*
Please contact me by:*	Email      Phone
If by phone, I would prefer to be contacted in the:	Select One Morning Afternoon
I am interested in the session on:*	1. What is dementia?  2. The principles of person-centred dementia care  3. Living with dementia  4. Communication: approaches and techniques  5. Supporting, enabling and promoting skills for people living with dementia  6. Looking after yourself  More than one session
I am interested in sessions held in the following area:*	Select One Derbyshire Greater London Lancashire Merseyside Midlands Northamptonshire Surrey Sussex Tyne & Wear Yorkshire
In submitting your enquiry, you are giving us permission to use your personal data (including sensitive personal data) contained in your enquiry, in line with our Privacy Statement. When we receive information from you via this page, and in dealing with your enquiry, we will work on the basis that you have read our statement and you accept it:*	Please click the box to confirm that you have accepted these terms and conditions.
By submitting your information to us you agree to being contacted for marketing purposes, and are happy to receive details of new services available from Anchor:	Please tick this box if you do not agree to being contacted for marketing purposes.
Would like other companies to send you information about related products and services:	Yes      No
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