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Congressional Report Form

Please tell us about your meeting or conversation with a legislator or staff.

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Your Details

Your Name*

Your Email*

Your Phone

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Ambassador?

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Meeting Details

Congressional Office*

Date of Contact*

Type of Contact* If other, please clarify below:

With whom did you meet?

Advocates in Attendance

Alzheimer's Legislation

Will Cosponsor HOPE for Alzheimer's Act*

Will the Representative/Senator cosponsor the HOPE for Alzheimer’s Act (S. 738/H.R. 1386)?*

Yes / Already a cosponsor

Is considering cosponsorship

Does not plan to cosponsor

Did not discuss

Will Cosponsor Breakthrough Act*

Will the Representative/Senator cosponsor the Alzheimer's Breakthrough Act (H.R. 1897)

Yes / Already a cosponsor

Is considering cosponsorship

Does not plan to cosponsor

Did not discuss

Notes on Alzheimer's Legislation

Other Meeting Notes

Other Topics Discussed in the Meeting

Member Personal Experience

The member of Congress mentioned a personal experience with Alzheimer's.

Staff Personal Experience

A Congressional staffer mentioned a personal experience with Alzheimer's

Is Follow-Up Needed?

Notes for meeting follow up

Follow Up Needed

National staff needs to promptly follow up on a question from this visit.

If you have any questions, please contact Aline Stone at Aline.Stone@alz.org or 202.638.8677

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