Skip to content
MIND Center
Search UMMC
Mobile Navigation
UMMC Navigation
⌂
UMMC Home
Education
Academic Affairs
School of Dentistry
School of Graduate Studies
School of Health Related Professions
School of Medicine
School of Nursing
School of Pharmacy
School of Population Health
Continuing Health Professional Education
Faculty Directory
For Faculty
For Students
Prospective Students
UMMC Online
Residents and Fellows
Rowland Medical Library
UMMC Bookstore
Health Care
Health Care Home
All UMMC Services
Children's of Mississippi
Find a Doctor
Find a Location
Pay a Bill
UMMC Pricing
Patient and Visitor Information
Referring Physicians
Research
Research Home
Centers and Institutes
Offices
Resources
Participate in Clinical Trials
About
A-Z Site Index
About Us
Accreditations
History
Jobs at UMMC
Leadership
Mission and Vision
Give
MyChart
Appointments
MIND Center
Care, Support and Resources
Clinical Services
Alzheimer's and Dementia at UMMC
Telehealth Services
Clinical Care Team
Locations and Directions
Resources
Resources Overview
Alzheimer's Facts and Figures
Alzheimer's Disease Education and Referral Center - External Site
Alzheimer's Association Mississippi Chapter - External Site
Mind Minute Newsletter
MS State Agency Services for Older Adults - PDF
Navigating Alzheimer's and Related Dementias
State Strategic Plan for Alzheimer's Disease and Related Dementias
State Strategic Plan Progress Report
Contact Us
For more information
Research
Our Vision
Our Director
Our Research Team
The Study of Aging
Contact Us
For more information
Education
Annual Conference
Educational Mission
Mind Matters Series
Caregiver University
Request a Speaker
Contact Us
For more information
Ways to Help
Give Today
Financial Support
Contact Us to Help You Make a Gift
Brawn and Bubbles 5K
Ride with The MIND Car Tag
Santé South Food and Wine Festival
Memories Matter.
Contact Us
For more information
MIND Center
Education
Education
Memory Impairment and Neurodegenerative Dementia Center (MIND Center)
Care, Support and Resources
Resources
Brain Health Awareness- Be Brain Mighty
Resources
Mind Minute Newsletter
Dementia Medication Update
AARP Global Council on Brain Health Report - PDF
Alzheimer's Disease Education and Referral Center - External Site
Alzheimer's Association Mississippi Chapter - External Site
Atherosclerosis Risk in Communities (ARIC) Study - External Site
MS State Agency Services for Older Adults - PDF
Navigating Alzheimer's and Related Dementias: A Roadmap for Families - PDF
State Strategic Plan for Alzheimer's Disease and Related Dementias - PDF
State Strategic Plan for Alzheimer's Disease and Related Dementias Progress Report - PDF
Alzheimer's Facts
Education
Education Home
Annual Conference
23rd Annual Conference on Alzheimer’s Disease and Related Dementias
2023 Sponsor/Exhibitor Opportunities
Registration
Sponsor Commitment Forms
Mind Matters Series
Caregiver University
Overview
Topic List
Request a Speaker
Request a Speaker Form
Research
Care Today ... A Cure Tomorrow
Our Director
Our Research Team
Ways to Help
Give Today
Financial Support
Contact Us to Make a Gift
Brawn and Bubbles
Ride with MIND Car Tag
Steps to Establish In Memoriam Gift
Contact Us
Main Content
MIND Center and Division of Geriatrics Speaker Request Form
*
= Required Fields
Organization
*
Name
*
Title
*
Address
*
City/State/Zip
*
City
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip Code
-
Office Phone Number
*
(
)
-
Cell Phone Number
*
(
)
-
Email Address
*
Event Title
*
Event Date
*
Event Time
*
Building Name
*
Location Address
*
Location City/State/Zip
*
City
State
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
Zip Code
-
Presentation Duration
*
Anticipated # of Attendees
*
Presentation Topic (Please select the topic that best fits your request. Additional information can be included in "Other")
*
Understanding Alzheimer's Disease and Dementia
Advances in Alzheimer's and Dementia Research
Brain Wellness and Prevention
Caregiver Support Strategies
Communication Techniques
Managing Challenging Behaviors
MIND Center Programs and Services
Other
Other Topic
Audience Profile (check all that apply)
*
General Public
Family Caregivers
Corporation
Health Care Professionals
Older Adults
Other
Other Profile
Please describe your audience.
*
Exhibit/Resource Table Requested?
*
Yes
No
AV Equipment needed
AV Equipment Provider
Host to provide
Speaker to provide
Will Continuing Education Credits be offered for the speaker's presentation?
*
Yes
No
Will a flyer or ads be created to promote the event? If so, we will need to review the artwork before distribution.
*
Yes
No
May we help to promote the event on our web and social media sites?
*
Yes
No
Additional Comments