Memory Walk : My Way

Submit your My Way Memory Walk & Jog event application

Personal Details

First Name *

Last Name *

Email Address *

Phone Number *

DOB *

Month *

Year *

Gender *

Male Female Other

Organisation Name

Postal Address

Unit Number

Street Number

Street *

City *

Postcode *

State *

Country *

Event Information

Reason for organising event *

Proposed Date *

Proposed Time *

Proposed location *

Will you sell tickets?

How many people might attend? *

Please specify the ticket names and prices

How much do you want to raise for Dementia Australia? *

Name of local council where event will be held *

Has the local council already approved the event? *

Will you have any entertainment or food and drinks stalls? *

If yes, please specify

Please provide a brief description of your event

I agree to the terms and conditions

Register to
Beat dementia, MyWay.

Host your own event your way for people impacted
by dementia.

Submit your My Way Memory Walk & Jog event application

Personal Details

Postal Address

Event Information

Register to Beat dementia, MyWay.

Host your own event your way for people impacted by dementia.

Submit your My Way Memory Walk & Jog event application

Personal Details

Postal Address

Event Information

Register to
Beat dementia, MyWay.

Host your own event your way for people impacted
by dementia.