Make the Commitment Campaign The Alzheimer Society is calling on the Canadian public to take action and make the commitment to better brain health. We want to hear from you! Fill out the form below and tell us how you plan to make the commitment to brain health. Click here to see how the Alzheimer Society of Canada staff is making the commitment. *Indicates a required field. First Name * Last Name * Address 1 * Postal Code * City * Province * Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Scotia Nunavut Ontario P.E.I. Quebec Saskatchewan Yukon Country * Email Address * Phone Number     I give the Alzheimer Society permission to use my commitment on their website to encourage others to make the commitment to brain health. (The Society will not reproduce any personal information without prior permission.) I give the Alzheimer Society permission to contact me by email.     Your friends' information. Subject Your message: INSERT E-NEWSLETTER Dear Alzheimer Society, I commit to Yours sincerely, Message Signoff

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