alzeducate.ca
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146.190.242.28
Public Scan
URL:
https://alzeducate.ca/login/signup.php
Submission: On June 25 via manual from IN — Scanned from CA
Submission: On June 25 via manual from IN — Scanned from CA
Form analysis 3 forms found in the DOM
POST https://alzeducate.ca/login/index.php
<form class="loginform" id="login" method="post" action="https://alzeducate.ca/login/index.php">
<div class="form-group"><input type="text" name="username" placeholder="Username" id="login_username" class="form-control" value="" autocomplete="username"></div>
<div class="form-group"><input type="password" name="password" id="login_password" placeholder="Password" class="form-control" value="" autocomplete="current-password"></div>
<div class="form-group custom-control custom-checkbox">
<input type="checkbox" class="custom-control-input" name="rememberusername" id="rememberusername">
<label class="custom-control-label" for="rememberusername">Remember username</label>
<a class="tdu btn-fpswd float-right" href="https://alzeducate.ca/login/forgot_password.php">Lost password?</a>
</div><button type="submit" class="btn btn-log btn-block btn-thm2">Log in</button><input type="hidden" name="logintoken" value="p4VivZZSIiH9J65b1XpfAYyjV7HFRba9">
</form>https://alzeducate.ca/search/index.php
<form class="ccn-mk-fullscreen-searchform" action="https://alzeducate.ca/search/index.php">
<fieldset><input id="searchform_search" name="q" class="ccn-mk-fullscreen-search-input" placeholder="Search courses..." type="text"
size="15"><i class="flaticon-magnifying-glass fullscreen-search-icon"><input value="" type="submit" id="searchform_button"></i></fieldset>
</form>POST https://alzeducate.ca/login/signup.php
<form autocomplete="off" action="https://alzeducate.ca/login/signup.php" method="post" accept-charset="utf-8" id="mform1_PSIML4rruCdthxg" class="mform full-width-labels" data-boost-form-errors-enhanced="1">
<div style="display: none;"><input name="sesskey" type="hidden" value="6UsWrTQ6nR">
<input name="_qf__login_signup_form" type="hidden" value="1">
<input name="mform_isexpanded_id_category_2" type="hidden" value="1">
<input name="mform_isexpanded_id_category_1" type="hidden" value="1">
<input name="mform_isexpanded_id_category_3" type="hidden" value="0">
<input name="mform_isexpanded_id_category_4" type="hidden" value="1">
</div>
<div class="collapsible-actions">
<a id="collapsesections667a3bdfc49a4667a3bdfc22984" href="#" aria-expanded="false" class="btn btn-link p-1 collapseexpand collapsemenu collapsed" role="button" aria-controls="collapseElement-0 collapseElement-1 collapseElement-2 collapseElement-3">
<span class="collapseall">Collapse all</span>
<span class="expandall">Expand all</span>
</a>
</div>
<div id="fitem_id_username" class="form-group row fitem ">
<div class="col-md-3 col-form-label d-flex pb-0 pr-md-0">
<label id="id_username_label" class="d-inline word-break " for="id_username"> Username </label>
<div class="form-label-addon d-flex align-items-center align-self-start">
<div class="text-danger" title="Required">
<i class="icon fa ccn-flaticon-warning text-danger fa-fw " title="Required" role="img" aria-label="Required"></i>
</div>
</div>
</div>
<div class="col-md-9 form-inline align-items-start felement" data-fieldtype="text">
<input type="text" class="form-control " name="username" id="id_username" value="" size="12" maxlength="100" autocapitalize="none">
<div class="form-control-feedback invalid-feedback" id="id_error_username">
</div>
</div>
</div>
<div id="fitem_id_passwordpolicyinfo" class="form-group row fitem femptylabel ">
<div class="col-md-3 col-form-label d-flex pb-0 pr-md-0">
<div class="form-label-addon d-flex align-items-center align-self-start">
</div>
</div>
<div class="col-md-9 form-inline align-items-start felement" data-fieldtype="static">
<div class="form-control-static"> The password must have at least 8 characters, at least 1 digit(s), at least 1 lower case letter(s), at least 1 upper case letter(s), at least 1 special character(s) such as as *, -, or # </div>
<div class="form-control-feedback invalid-feedback" id="id_error_passwordpolicyinfo">
</div>
</div>
</div>
<div id="fitem_id_password" class="form-group row fitem ">
<div class="col-md-3 col-form-label d-flex pb-0 pr-md-0">
<label id="id_password_label" class="d-inline word-break " for="id_password"> Password </label>
<div class="form-label-addon d-flex align-items-center align-self-start">
<div class="text-danger" title="Required">
<i class="icon fa ccn-flaticon-warning text-danger fa-fw " title="Required" role="img" aria-label="Required"></i>
</div>
</div>
</div>
<div class="col-md-9 form-inline align-items-start felement" data-fieldtype="password">
<input type="password" class="form-control " name="password" id="id_password" value="" size="12" maxlength="32" autocomplete="new-password">
<div class="form-control-feedback invalid-feedback" id="id_error_password">
</div>
</div>
</div>
<div id="fitem_id_email" class="form-group row fitem ">
<div class="col-md-3 col-form-label d-flex pb-0 pr-md-0">
<label id="id_email_label" class="d-inline word-break " for="id_email"> Email address </label>
<div class="form-label-addon d-flex align-items-center align-self-start">
<div class="text-danger" title="Required">
<i class="icon fa ccn-flaticon-warning text-danger fa-fw " title="Required" role="img" aria-label="Required"></i>
</div>
</div>
</div>
<div class="col-md-9 form-inline align-items-start felement" data-fieldtype="text">
<input type="text" class="form-control " name="email" id="id_email" value="" size="25" maxlength="100">
<div class="form-control-feedback invalid-feedback" id="id_error_email">
</div>
</div>
</div>
<div id="fitem_id_email2" class="form-group row fitem ">
<div class="col-md-3 col-form-label d-flex pb-0 pr-md-0">
<label id="id_email2_label" class="d-inline word-break " for="id_email2"> Email (again) </label>
<div class="form-label-addon d-flex align-items-center align-self-start">
<div class="text-danger" title="Required">
<i class="icon fa ccn-flaticon-warning text-danger fa-fw " title="Required" role="img" aria-label="Required"></i>
</div>
</div>
</div>
<div class="col-md-9 form-inline align-items-start felement" data-fieldtype="text">
<input type="text" class="form-control " name="email2" id="id_email2" value="" size="25" maxlength="100">
<div class="form-control-feedback invalid-feedback" id="id_error_email2">
</div>
</div>
</div>
<div id="fitem_id_firstname" class="form-group row fitem ">
<div class="col-md-3 col-form-label d-flex pb-0 pr-md-0">
<label id="id_firstname_label" class="d-inline word-break " for="id_firstname"> First name </label>
<div class="form-label-addon d-flex align-items-center align-self-start">
<div class="text-danger" title="Required">
<i class="icon fa ccn-flaticon-warning text-danger fa-fw " title="Required" role="img" aria-label="Required"></i>
</div>
</div>
</div>
<div class="col-md-9 form-inline align-items-start felement" data-fieldtype="text">
<input type="text" class="form-control " name="firstname" id="id_firstname" value="" size="30" maxlength="100">
<div class="form-control-feedback invalid-feedback" id="id_error_firstname">
</div>
</div>
</div>
<div id="fitem_id_lastname" class="form-group row fitem ">
<div class="col-md-3 col-form-label d-flex pb-0 pr-md-0">
<label id="id_lastname_label" class="d-inline word-break " for="id_lastname"> Surname </label>
<div class="form-label-addon d-flex align-items-center align-self-start">
<div class="text-danger" title="Required">
<i class="icon fa ccn-flaticon-warning text-danger fa-fw " title="Required" role="img" aria-label="Required"></i>
</div>
</div>
</div>
<div class="col-md-9 form-inline align-items-start felement" data-fieldtype="text">
<input type="text" class="form-control " name="lastname" id="id_lastname" value="" size="30" maxlength="100">
<div class="form-control-feedback invalid-feedback" id="id_error_lastname">
</div>
</div>
</div>
<div id="fitem_id_city" class="form-group row fitem ">
<div class="col-md-3 col-form-label d-flex pb-0 pr-md-0">
<label id="id_city_label" class="d-inline word-break " for="id_city"> City/town </label>
<div class="form-label-addon d-flex align-items-center align-self-start">
</div>
</div>
<div class="col-md-9 form-inline align-items-start felement" data-fieldtype="text">
<input type="text" class="form-control " name="city" id="id_city" value="" size="20" maxlength="120">
<div class="form-control-feedback invalid-feedback" id="id_error_city">
</div>
</div>
</div>
<div id="fitem_id_profile_field_mailingprovince" class="form-group row fitem ">
<div class="col-md-3 col-form-label d-flex pb-0 pr-md-0">
<label id="id_profile_field_mailingprovince_label" class="d-inline word-break " for="id_profile_field_mailingprovince"> State/Province </label>
<div class="form-label-addon d-flex align-items-center align-self-start">
<div class="text-danger" title="Required">
<i class="icon fa ccn-flaticon-warning text-danger fa-fw " title="Required" role="img" aria-label="Required"></i>
</div>
</div>
</div>
<div class="col-md-9 form-inline align-items-start felement" data-fieldtype="select">
<select class="custom-select
" name="profile_field_mailingprovince" id="id_profile_field_mailingprovince">
<option value="">Choose...</option>
<option value="AB">AB</option>
<option value="BC">BC</option>
<option value="MB">MB</option>
<option value="NB">NB</option>
<option value="NL">NL</option>
<option value="NT">NT</option>
<option value="NS">NS</option>
<option value="NU">NU</option>
<option value="ON" selected="">ON</option>
<option value="PE">PE</option>
<option value="QC">QC</option>
<option value="SK">SK</option>
<option value="YT">YT</option>
<option value="AL">AL</option>
<option value="AK">AK</option>
<option value="AZ">AZ</option>
<option value="AR">AR</option>
<option value="CA">CA</option>
<option value="CO">CO</option>
<option value="CT">CT</option>
<option value="DE">DE</option>
<option value="FL">FL</option>
<option value="GA">GA</option>
<option value="HI">HI</option>
<option value="ID">ID</option>
<option value="IL">IL</option>
<option value="IN">IN</option>
<option value="IA">IA</option>
<option value="KS">KS</option>
<option value="KY">KY</option>
<option value="LA">LA</option>
<option value="ME">ME</option>
<option value="MD">MD</option>
<option value="MA">MA</option>
<option value="MI">MI</option>
<option value="MN">MN</option>
<option value="MS">MS</option>
<option value="MO">MO</option>
<option value="MT">MT</option>
<option value="NE">NE</option>
<option value="NV">NV</option>
<option value="NH">NH</option>
<option value="NJ">NJ</option>
<option value="NM">NM</option>
<option value="NY">NY</option>
<option value="NC">NC</option>
<option value="ND">ND</option>
<option value="OH">OH</option>
<option value="OK">OK</option>
<option value="OR">OR</option>
<option value="PA">PA</option>
<option value="RI">RI</option>
<option value="SC">SC</option>
<option value="SD">SD</option>
<option value="TN">TN</option>
<option value="TX">TX</option>
<option value="UT">UT</option>
<option value="VT">VT</option>
<option value="VA">VA</option>
<option value="WA">WA</option>
<option value="WV">WV</option>
<option value="WI">WI</option>
<option value="WY">WY</option>
<option value="Other">Other</option>
</select>
<div class="form-control-feedback invalid-feedback" id="id_error_profile_field_mailingprovince">
</div>
</div>
</div>
<div id="fitem_id_country" class="form-group row fitem ">
<div class="col-md-3 col-form-label d-flex pb-0 pr-md-0">
<label id="id_country_label" class="d-inline word-break " for="id_country"> Country </label>
<div class="form-label-addon d-flex align-items-center align-self-start">
</div>
</div>
<div class="col-md-9 form-inline align-items-start felement" data-fieldtype="select">
<select class="custom-select
" name="country" id="id_country">
<option value="">Select a country</option>
<option value="AF">Afghanistan</option>
<option value="AX">Åland Islands</option>
<option value="AL">Albania</option>
<option value="DZ">Algeria</option>
<option value="AS">American Samoa</option>
<option value="AD">Andorra</option>
<option value="AO">Angola</option>
<option value="AI">Anguilla</option>
<option value="AQ">Antarctica</option>
<option value="AG">Antigua and Barbuda</option>
<option value="AR">Argentina</option>
<option value="AM">Armenia</option>
<option value="AW">Aruba</option>
<option value="AU">Australia</option>
<option value="AT">Austria</option>
<option value="AZ">Azerbaijan</option>
<option value="BS">Bahamas</option>
<option value="BH">Bahrain</option>
<option value="BD">Bangladesh</option>
<option value="BB">Barbados</option>
<option value="BY">Belarus</option>
<option value="BE">Belgium</option>
<option value="BZ">Belize</option>
<option value="BJ">Benin</option>
<option value="BM">Bermuda</option>
<option value="BT">Bhutan</option>
<option value="BO">Bolivia (Plurinational State of)</option>
<option value="BQ">Bonaire, Sint Eustatius and Saba</option>
<option value="BA">Bosnia and Herzegovina</option>
<option value="BW">Botswana</option>
<option value="BV">Bouvet Island</option>
<option value="BR">Brazil</option>
<option value="IO">British Indian Ocean Territory</option>
<option value="BN">Brunei Darussalam</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina Faso</option>
<option value="BI">Burundi</option>
<option value="CV">Cabo Verde</option>
<option value="KH">Cambodia</option>
<option value="CM">Cameroon</option>
<option value="CA" selected="">Canada</option>
<option value="KY">Cayman Islands</option>
<option value="CF">Central African Republic</option>
<option value="TD">Chad</option>
<option value="CL">Chile</option>
<option value="CN">China</option>
<option value="CX">Christmas Island</option>
<option value="CC">Cocos (Keeling) Islands</option>
<option value="CO">Colombia</option>
<option value="KM">Comoros</option>
<option value="CG">Congo</option>
<option value="CD">Congo (the Democratic Republic of the)</option>
<option value="CK">Cook Islands</option>
<option value="CR">Costa Rica</option>
<option value="CI">Côte d'Ivoire</option>
<option value="HR">Croatia</option>
<option value="CU">Cuba</option>
<option value="CW">Curaçao</option>
<option value="CY">Cyprus</option>
<option value="CZ">Czechia</option>
<option value="DK">Denmark</option>
<option value="DJ">Djibouti</option>
<option value="DM">Dominica</option>
<option value="DO">Dominican Republic</option>
<option value="EC">Ecuador</option>
<option value="EG">Egypt</option>
<option value="SV">El Salvador</option>
<option value="GQ">Equatorial Guinea</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="SZ">Eswatini</option>
<option value="ET">Ethiopia</option>
<option value="FK">Falkland Islands (Malvinas)</option>
<option value="FO">Faroe Islands</option>
<option value="FJ">Fiji</option>
<option value="FI">Finland</option>
<option value="FR">France</option>
<option value="GF">French Guiana</option>
<option value="PF">French Polynesia</option>
<option value="TF">French Southern Territories</option>
<option value="GA">Gabon</option>
<option value="GM">Gambia</option>
<option value="GE">Georgia</option>
<option value="DE">Germany</option>
<option value="GH">Ghana</option>
<option value="GI">Gibraltar</option>
<option value="GR">Greece</option>
<option value="GL">Greenland</option>
<option value="GD">Grenada</option>
<option value="GP">Guadeloupe</option>
<option value="GU">Guam</option>
<option value="GT">Guatemala</option>
<option value="GG">Guernsey</option>
<option value="GN">Guinea</option>
<option value="GW">Guinea-Bissau</option>
<option value="GY">Guyana</option>
<option value="HT">Haiti</option>
<option value="HM">Heard Island and McDonald Islands</option>
<option value="VA">Holy See</option>
<option value="HN">Honduras</option>
<option value="HK">Hong Kong</option>
<option value="HU">Hungary</option>
<option value="IS">Iceland</option>
<option value="IN">India</option>
<option value="ID">Indonesia</option>
<option value="IR">Iran (Islamic Republic of)</option>
<option value="IQ">Iraq</option>
<option value="IE">Ireland</option>
<option value="IM">Isle of Man</option>
<option value="IL">Israel</option>
<option value="IT">Italy</option>
<option value="JM">Jamaica</option>
<option value="JP">Japan</option>
<option value="JE">Jersey</option>
<option value="JO">Jordan</option>
<option value="KZ">Kazakhstan</option>
<option value="KE">Kenya</option>
<option value="KI">Kiribati</option>
<option value="KP">Korea (the Democratic People's Republic of)</option>
<option value="KR">Korea (the Republic of)</option>
<option value="KW">Kuwait</option>
<option value="KG">Kyrgyzstan</option>
<option value="LA">Lao People's Democratic Republic</option>
<option value="LV">Latvia</option>
<option value="LB">Lebanon</option>
<option value="LS">Lesotho</option>
<option value="LR">Liberia</option>
<option value="LY">Libya</option>
<option value="LI">Liechtenstein</option>
<option value="LT">Lithuania</option>
<option value="LU">Luxembourg</option>
<option value="MO">Macao</option>
<option value="MG">Madagascar</option>
<option value="MW">Malawi</option>
<option value="MY">Malaysia</option>
<option value="MV">Maldives</option>
<option value="ML">Mali</option>
<option value="MT">Malta</option>
<option value="MH">Marshall Islands</option>
<option value="MQ">Martinique</option>
<option value="MR">Mauritania</option>
<option value="MU">Mauritius</option>
<option value="YT">Mayotte</option>
<option value="MX">Mexico</option>
<option value="FM">Micronesia (Federated States of)</option>
<option value="MD">Moldova (the Republic of)</option>
<option value="MC">Monaco</option>
<option value="MN">Mongolia</option>
<option value="ME">Montenegro</option>
<option value="MS">Montserrat</option>
<option value="MA">Morocco</option>
<option value="MZ">Mozambique</option>
<option value="MM">Myanmar</option>
<option value="NA">Namibia</option>
<option value="NR">Nauru</option>
<option value="NP">Nepal</option>
<option value="NL">Netherlands</option>
<option value="NC">New Caledonia</option>
<option value="NZ">New Zealand</option>
<option value="NI">Nicaragua</option>
<option value="NE">Niger</option>
<option value="NG">Nigeria</option>
<option value="NU">Niue</option>
<option value="NF">Norfolk Island</option>
<option value="MK">North Macedonia</option>
<option value="MP">Northern Mariana Islands</option>
<option value="NO">Norway</option>
<option value="OM">Oman</option>
<option value="PK">Pakistan</option>
<option value="PW">Palau</option>
<option value="PS">Palestine, State of</option>
<option value="PA">Panama</option>
<option value="PG">Papua New Guinea</option>
<option value="PY">Paraguay</option>
<option value="PE">Peru</option>
<option value="PH">Philippines</option>
<option value="PN">Pitcairn</option>
<option value="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="PR">Puerto Rico</option>
<option value="QA">Qatar</option>
<option value="RE">Réunion</option>
<option value="RO">Romania</option>
<option value="RU">Russian Federation</option>
<option value="RW">Rwanda</option>
<option value="BL">Saint Barthélemy</option>
<option value="SH">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="KN">Saint Kitts and Nevis</option>
<option value="LC">Saint Lucia</option>
<option value="MF">Saint Martin (French part)</option>
<option value="PM">Saint Pierre and Miquelon</option>
<option value="VC">Saint Vincent and the Grenadines</option>
<option value="WS">Samoa</option>
<option value="SM">San Marino</option>
<option value="ST">Sao Tome and Principe</option>
<option value="SA">Saudi Arabia</option>
<option value="SN">Senegal</option>
<option value="RS">Serbia</option>
<option value="SC">Seychelles</option>
<option value="SL">Sierra Leone</option>
<option value="SG">Singapore</option>
<option value="SX">Sint Maarten (Dutch part)</option>
<option value="SK">Slovakia</option>
<option value="SI">Slovenia</option>
<option value="SB">Solomon Islands</option>
<option value="SO">Somalia</option>
<option value="ZA">South Africa</option>
<option value="GS">South Georgia and the South Sandwich Islands</option>
<option value="SS">South Sudan</option>
<option value="ES">Spain</option>
<option value="LK">Sri Lanka</option>
<option value="SD">Sudan</option>
<option value="SR">Suriname</option>
<option value="SJ">Svalbard and Jan Mayen</option>
<option value="SE">Sweden</option>
<option value="CH">Switzerland</option>
<option value="SY">Syrian Arab Republic</option>
<option value="TW">Taiwan</option>
<option value="TJ">Tajikistan</option>
<option value="TZ">Tanzania, the United Republic of</option>
<option value="TH">Thailand</option>
<option value="TL">Timor-Leste</option>
<option value="TG">Togo</option>
<option value="TK">Tokelau</option>
<option value="TO">Tonga</option>
<option value="TT">Trinidad and Tobago</option>
<option value="TN">Tunisia</option>
<option value="TR">Turkey</option>
<option value="TM">Turkmenistan</option>
<option value="TC">Turks and Caicos Islands</option>
<option value="TV">Tuvalu</option>
<option value="UG">Uganda</option>
<option value="UA">Ukraine</option>
<option value="AE">United Arab Emirates</option>
<option value="GB">United Kingdom</option>
<option value="US">United States</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UY">Uruguay</option>
<option value="UZ">Uzbekistan</option>
<option value="VU">Vanuatu</option>
<option value="VE">Venezuela (Bolivarian Republic of)</option>
<option value="VN">Viet Nam</option>
<option value="VG">Virgin Islands (British)</option>
<option value="VI">Virgin Islands (U.S.)</option>
<option value="WF">Wallis and Futuna</option>
<option value="EH">Western Sahara</option>
<option value="YE">Yemen</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
</select>
<div class="form-control-feedback invalid-feedback" id="id_error_country">
</div>
</div>
</div>
<fieldset class="clearfix collapsible" id="id_category_2">
<legend class="d-flex align-items-center">
<div class="position-relative d-flex ftoggler align-items-center position-relative mr-1">
<a data-toggle="collapse" href="#id_category_2container" role="button" aria-expanded="true" aria-controls="id_category_2container" class=" btn-icon mr-1 icons-collapse-expand stretched-link fheader " id="collapseElement-0">
<span class="expanded-icon icon-no-margin p-2" title="Collapse">
<i class="icon fa fa-chevron-down fa-fw " aria-hidden="true"></i>
</span>
<span class="collapsed-icon icon-no-margin p-2" title="Expand">
<span class="dir-rtl-hide"><i class="icon fa fa-chevron-right fa-fw " aria-hidden="true"></i></span>
<span class="dir-ltr-hide"><i class="icon fa fa-chevron-left fa-fw " aria-hidden="true"></i></span>
</span>
<span class="sr-only">Tell us about your dementia care role</span>
</a>
<h3 class="d-flex align-self-stretch align-items-center mb-0" aria-hidden="true"> Tell us about your dementia care role </h3>
</div>
</legend>
<div id="id_category_2container" class="fcontainer collapseable collapse show">
<div id="fitem_id_profile_field_role" class="form-group row fitem ">
<div class="col-md-3 col-form-label d-flex pb-0 pr-md-0">
<label id="id_profile_field_role_label" class="d-inline word-break " for="id_profile_field_role"> Your role </label>
<div class="form-label-addon d-flex align-items-center align-self-start">
<div class="text-danger" title="Required">
<i class="icon fa ccn-flaticon-warning text-danger fa-fw " title="Required" role="img" aria-label="Required"></i>
</div>
</div>
</div>
<div class="col-md-9 form-inline align-items-start felement" data-fieldtype="select">
<select class="custom-select
" name="profile_field_role" id="id_profile_field_role">
<option value="" selected="">Choose...</option>
<option value="<span lang="en" class="multilang">Health Care Provider</span><span lang="fr-ca" class="multilang">Fournisseur de soins de santé</span>">Health Care Provider</option>
<option value="<span lang="en" class="multilang">Family Caregiver</span><span lang="fr-ca" class="multilang">Proche aidant</span>">Family Caregiver</option>
<option value="<span lang="en" class="multilang">Person with Dementia</span><span lang="fr-ca" class="multilang">Personne atteinte de la maladie d'Alzheimer</span>">Person with Dementia</option>
<option value="<span lang="en" class="multilang">General Public</span><span lang="fr-ca" class="multilang">Grand public</span>">General Public</option>
<option value="<span lang="en" class="multilang">First Responder</span><span lang="fr-ca" class="multilang">Premier répondant</span>">First Responder</option>
<option value="<span lang="en" class="multilang">Service Sector</span><span lang="fr-ca" class="multilang">Secteur des services</span>">Service Sector</option>
<option value="<span lang="en" class="multilang">Alzheimer Society Staff / Volunteer</span><span lang="fr-ca" class="multilang">Bénévole / Personnel de la Société Alzheimer</span>">Alzheimer Society
Staff / Volunteer</option>
<option value="<span lang="en" class="multilang">Other</span><span lang="fr-ca" class="multilang">Autre</span>">Other</option>
</select>
<div class="form-control-feedback invalid-feedback" id="id_error_profile_field_role">
</div>
</div>
</div>
<div id="fitem_id_profile_field_healthcarerole" class="form-group row fitem " style="display: none;">
<div class="col-md-3 col-form-label d-flex pb-0 pr-md-0">
<label id="id_profile_field_healthcarerole_label" class="d-inline word-break " for="id_profile_field_healthcarerole"> Health Care Provider Role </label>
<div class="form-label-addon d-flex align-items-center align-self-start">
</div>
</div>
<div class="col-md-9 form-inline align-items-start felement" data-fieldtype="select">
<select class="custom-select
" name="profile_field_healthcarerole" id="id_profile_field_healthcarerole">
<option value="<span lang="en" class="multilang">None</span><span lang="fr-ca" class="multilang">Nul</span>">None</option>
<option value="<span lang="en" class="multilang">Personal Support Worker</span><span lang="fr-ca" class="multilang">Préposé ou préposée au service de soutien personnel</span>">Personal Support
Worker</option>
<option value="<span lang="en" class="multilang">Social Worker / Social Service Worker</span><span lang="fr-ca" class="multilang">Travailleur social ou travailleuse sociale</span>">Social Worker /
Social Service Worker</option>
<option value="<span lang="en" class="multilang">Case Manager</span><span lang="fr-ca" class="multilang">Gestionnaire de cas</span>">Case Manager</option>
<option
value="<span lang="en" class="multilang">RN / RPN</span><span lang="fr-ca" class="multilang">Infirmier autorisé / infirmière autorisée ou infirmier auxiliaire autorisé / infirmière auxiliaire autorisée</span>">
RN / RPN</option>
<option
value="<span lang="en" class="multilang">OT / PT / OTA / PTA</span><span lang="fr-ca" class="multilang">Ergothérapeute / physiothérapeute / aide-ergothérapeute / aide-physiothérapeute</span>">OT /
PT / OTA / PTA</option>
<option value="<span lang="en" class="multilang">Recreation</span><span lang="fr-ca" class="multilang">Loisirs</span>">Recreation</option>
<option value="<span lang="en" class="multilang">Other</span><span lang="fr-ca" class="multilang">Autre</span>">Other</option>
<option value="<span lang="en" class="multilang">Privately Paid Caregiver</span><span lang="fr-ca" class="multilang">Personnel soignant ou aidant professionnel</span>">Privately Paid Caregiver
</option>
</select>
<div class="form-control-feedback invalid-feedback" id="id_error_profile_field_healthcarerole">
</div>
</div>
</div>
<div id="fitem_id_profile_field_employmentfield" class="form-group row fitem " style="display: none;">
<div class="col-md-3 col-form-label d-flex pb-0 pr-md-0">
<label id="id_profile_field_employmentfield_label" class="d-inline word-break " for="id_profile_field_employmentfield"> Primary Field of Employment </label>
<div class="form-label-addon d-flex align-items-center align-self-start">
</div>
</div>
<div class="col-md-9 form-inline align-items-start felement" data-fieldtype="select">
<select class="custom-select
" name="profile_field_employmentfield" id="id_profile_field_employmentfield">
<option value="<span lang="en" class="multilang">Retirement Home</span><span lang="fr-ca" class="multilang">Résidence pour personnes âgées</span>">Retirement Home</option>
<option value="<span lang="en" class="multilang">Acute Care / Hospital</span><span lang="fr-ca" class="multilang">Soins actifs / hôpital</span>">Acute Care / Hospital</option>
<option value="<span lang="en" class="multilang">Supportive Housing</span><span lang="fr-ca" class="multilang">Logements avec services de soutien</span>">Supportive Housing</option>
<option value="<span lang="en" class="multilang">Long-term Care</span><span lang="fr-ca" class="multilang">Soins de longue durée</span>">Long-term Care</option>
<option value="<span lang="en" class="multilang">Community Agency</span><span lang="fr-ca" class="multilang">Organisme communautaire</span>">Community Agency</option>
<option value="<span lang="en" class="multilang">Other</span><span lang="fr-ca" class="multilang">Autre</span>">Other</option>
<option value="<span lang="en" class="multilang">None</span><span lang="fr-ca" class="multilang">Nul</span>" selected="">None</option>
</select>
<div class="form-control-feedback invalid-feedback" id="id_error_profile_field_employmentfield">
</div>
</div>
</div>
<div id="fitem_id_profile_field_employer" class="form-group row fitem " style="display: none;">
<div class="col-md-3 col-form-label d-flex pb-0 pr-md-0">
<label id="id_profile_field_employer_label" class="d-inline word-break " for="id_profile_field_employer"> Name of Employer </label>
<div class="form-label-addon d-flex align-items-center align-self-start">
</div>
</div>
<div class="col-md-9 form-inline align-items-start felement" data-fieldtype="text">
<input type="text" class="form-control " name="profile_field_employer" id="id_profile_field_employer" value="" size="30" maxlength="2048">
<div class="form-control-feedback invalid-feedback" id="id_error_profile_field_employer">
</div>
</div>
</div>
<div id="fitem_id_profile_field_responderrole" class="form-group row fitem " style="display: none;">
<div class="col-md-3 col-form-label d-flex pb-0 pr-md-0">
<label id="id_profile_field_responderrole_label" class="d-inline word-break " for="id_profile_field_responderrole"> First Responder Role </label>
<div class="form-label-addon d-flex align-items-center align-self-start">
</div>
</div>
<div class="col-md-9 form-inline align-items-start felement" data-fieldtype="select">
<select class="custom-select
" name="profile_field_responderrole" id="id_profile_field_responderrole">
<option value="<span lang="en" class="multilang">None</span><span lang="fr-ca" class="multilang">Nul</span>" selected="">None</option>
<option value="<span lang="en" class="multilang">Fire</span><span lang="fr-ca" class="multilang">Services d'incendie</span>">Fire</option>
<option value="<span lang="en" class="multilang">Paramedic</span><span lang="fr-ca" class="multilang">Services ambulanciers</span>">Paramedic</option>
<option value="<span lang="en" class="multilang">Police</span><span lang="fr-ca" class="multilang">Services de police</span>">Police</option>
<option value="<span lang="en" class="multilang">Other</span><span lang="fr-ca" class="multilang">Autre</span>">Other</option>
</select>
<div class="form-control-feedback invalid-feedback" id="id_error_profile_field_responderrole">
</div>
</div>
</div>
<div id="fitem_id_profile_field_servicesectorrole" class="form-group row fitem " style="display: none;">
<div class="col-md-3 col-form-label d-flex pb-0 pr-md-0">
<label id="id_profile_field_servicesectorrole_label" class="d-inline word-break " for="id_profile_field_servicesectorrole"> Service Sector </label>
<div class="form-label-addon d-flex align-items-center align-self-start">
</div>
</div>
<div class="col-md-9 form-inline align-items-start felement" data-fieldtype="select">
<select class="custom-select
" name="profile_field_servicesectorrole" id="id_profile_field_servicesectorrole">
<option value="<span lang="en" class="multilang">None</span><span lang="fr-ca" class="multilang">Nul</span>" selected="">None</option>
<option value="<span lang="en" class="multilang">Recreation</span><span lang="fr-ca" class="multilang">Loisirs</span>">Recreation</option>
<option value="<span lang="en" class="multilang">Retail</span><span lang="fr-ca" class="multilang">Vendre au détail</span>">Retail</option>
<option value="<span lang="en" class="multilang">Library</span><span lang="fr-ca" class="multilang">Bibliothèques</span>">Library</option>
<option value="<span lang="en" class="multilang">Restaurant</span><span lang="fr-ca" class="multilang">Restaurant</span>">Restaurant</option>
<option value="<span lang="en" class="multilang">Other</span><span lang="fr-ca" class="multilang">Autre</span>">Other</option>
</select>
<div class="form-control-feedback invalid-feedback" id="id_error_profile_field_servicesectorrole">
</div>
</div>
</div>
<div id="fitem_id_profile_field_servicesectorposition" class="form-group row fitem " style="display: none;">
<div class="col-md-3 col-form-label d-flex pb-0 pr-md-0">
<label id="id_profile_field_servicesectorposition_label" class="d-inline word-break " for="id_profile_field_servicesectorposition"> Service Sector Position </label>
<div class="form-label-addon d-flex align-items-center align-self-start">
</div>
</div>
<div class="col-md-9 form-inline align-items-start felement" data-fieldtype="select">
<select class="custom-select
" name="profile_field_servicesectorposition" id="id_profile_field_servicesectorposition">
<option value="<span lang="en" class="multilang">None</span><span lang="fr-ca" class="multilang">Nul</span>" selected="">None</option>
<option value="<span lang="en" class="multilang">Staff</span><span lang="fr-ca" class="multilang">rôle du personnel</span>">Staff</option>
<option value="<span lang="en" class="multilang">Temporary employee (contract, intern, co-op student, etc.)</span><span lang="fr-ca" class="multilang">employé temporaire</span>">Temporary employee
(contract, intern, co-op student, etc.)</option>
<option value="<span lang="en" class="multilang">Volunteer</span><span lang="fr-ca" class="multilang">bénévole</span>">Volunteer</option>
<option value="<span lang="en" class="multilang">Board member</span><span lang="fr-ca" class="multilang">membre d'équipage</span>">Board member</option>
<option value="<span lang="en" class="multilang">Leadership (director, owner, manager, supervisor, etc.)</span><span lang="fr-ca" class="multilang">rôle de leader</span>">Leadership (director,
owner, manager, supervisor, etc.)</option>
<option value="<span lang="en" class="multilang">Other</span><span lang="fr-ca" class="multilang">Autre</span>">Other</option>
</select>
<div class="form-control-feedback invalid-feedback" id="id_error_profile_field_servicesectorposition">
</div>
</div>
</div>
<div id="fitem_id_profile_field_society" class="form-group row fitem " style="display: none;">
<div class="col-md-3 col-form-label d-flex pb-0 pr-md-0">
<label id="id_profile_field_society_label" class="d-inline word-break " for="id_profile_field_society"> Society </label>
<div class="form-label-addon d-flex align-items-center align-self-start">
</div>
</div>
<div class="col-md-9 form-inline align-items-start felement" data-fieldtype="select">
<select class="custom-select
" name="profile_field_society" id="id_profile_field_society">
<option value="None" selected="">None</option>
<option value="Alzheimer Society of Canada">Alzheimer Society of Canada</option>
<option value="Alzheimer Society of Alberta and Northwest Territories">Alzheimer Society of Alberta and Northwest Territories</option>
<option value="Alzheimer Society of British Columbia">Alzheimer Society of British Columbia</option>
<option value="Alzheimer Society of Manitoba">Alzheimer Society of Manitoba</option>
<option value="Alzheimer Society of New Brunswick">Alzheimer Society of New Brunswick</option>
<option value="Alzheimer Society of Newfoundland and Labrador">Alzheimer Society of Newfoundland and Labrador</option>
<option value="Alzheimer Society of Nova Scotia">Alzheimer Society of Nova Scotia</option>
<option value="Alzheimer Society of Ontario">Alzheimer Society of Ontario</option>
<option value="Alzheimer Society of Prince Edward Island">Alzheimer Society of Prince Edward Island</option>
<option value="Alzheimer Society of Quebec">Alzheimer Society of Quebec</option>
<option value="Alzheimer Society of Saskatchewan">Alzheimer Society of Saskatchewan</option>
<option value="Brant, Haldimand Norfolk, Hamilton Halton">Brant, Haldimand Norfolk, Hamilton Halton</option>
<option value="Chatham Kent">Chatham Kent</option>
<option value="Cornwall and District">Cornwall and District</option>
<option value="Dufferin County">Dufferin County</option>
<option value="Durham Region">Durham Region</option>
<option value="Elgin-St. Thomas">Elgin-St. Thomas</option>
<option value="Grey-Bruce">Grey-Bruce</option>
<option value="Hastings - Prince Edward">Hastings - Prince Edward</option>
<option value="Huron County">Huron County</option>
<option value="Kenora / Rainy River Districts">Kenora / Rainy River Districts</option>
<option value="Kingston, Frontenac, Lennox and Addington">Kingston, Frontenac, Lennox and Addington</option>
<option value="Lanark Leeds Grenville">Lanark Leeds Grenville</option>
<option value="London and Middlesex">London and Middlesex</option>
<option value="Muskoka">Muskoka</option>
<option value="Niagara Region">Niagara Region</option>
<option value="Ottawa and Renfrew County">Ottawa and Renfrew County</option>
<option value="Oxford">Oxford</option>
<option value="Peel">Peel</option>
<option value="Perth County">Perth County</option>
<option value="Peterborough, Kawartha Lakes, Northumberland, and Haliburton">Peterborough, Kawartha Lakes, Northumberland, and Haliburton</option>
<option value="Sarnia-Lambton">Sarnia-Lambton</option>
<option value="Sault Ste. Marie and Algoma District">Sault Ste. Marie and Algoma District</option>
<option value="Simcoe County">Simcoe County</option>
<option value="Sudbury-Manitoulin North Bay and Districts">Sudbury-Manitoulin North Bay and Districts</option>
<option value="Thunder Bay">Thunder Bay</option>
<option value="Timmins-Porcupine District">Timmins-Porcupine District</option>
<option value="Toronto">Toronto</option>
<option value="Waterloo Wellington">Waterloo Wellington</option>
<option value="Windsor-Essex County">Windsor-Essex County</option>
<option value="York Region">York Region</option>
<option value="Abitibi-Témiscamingue">Abitibi-Témiscamingue</option>
<option value="Bas-Saint-Laurent">Bas-Saint-Laurent</option>
<option value="Centre-du-Québec">Centre-du-Québec</option>
<option value="Chaudière-Appalaches">Chaudière-Appalaches</option>
<option value="Côte-Nord">Côte-Nord</option>
<option value="Estrie">Estrie</option>
<option value="Gaspésie–Îles-de-la-Madeleine">Gaspésie–Îles-de-la-Madeleine</option>
<option value="Granby et Région">Granby et Région</option>
<option value="Haut-Richelieu">Haut-Richelieu</option>
<option value="Lanaudière">Lanaudière</option>
<option value="Laurentides">Laurentides</option>
<option value="Laval">Laval</option>
<option value="Maskoutains-Vallée des Patriotes">Maskoutains-Vallée des Patriotes</option>
<option value="Montréal">Montréal</option>
<option value="Outaouais">Outaouais</option>
<option value="Québec">Québec</option>
<option value="Rive-Sud">Rive-Sud</option>
<option value="Saguenay-Lac-Saint-Jean">Saguenay-Lac-Saint-Jean</option>
<option value="Suroît">Suroît</option>
</select>
<div class="form-control-feedback invalid-feedback" id="id_error_profile_field_society">
</div>
</div>
</div>
<div id="fitem_id_profile_field_roleother" class="form-group row fitem " style="display: none;">
<div class="col-md-3 col-form-label d-flex pb-0 pr-md-0">
<label id="id_profile_field_roleother_label" class="d-inline word-break " for="id_profile_field_roleother"> Other Dementia Care Role </label>
<div class="form-label-addon d-flex align-items-center align-self-start">
</div>
</div>
<div class="col-md-9 form-inline align-items-start felement" data-fieldtype="text">
<input type="text" class="form-control " name="profile_field_roleother" id="id_profile_field_roleother" value="" size="30" maxlength="2048">
<div class="form-control-feedback invalid-feedback" id="id_error_profile_field_roleother">
</div>
</div>
</div>
<div id="fitem_id_profile_field_alzrole" class="form-group row fitem " style="display: none;">
<div class="col-md-3 col-form-label d-flex pb-0 pr-md-0">
<label id="id_profile_field_alzrole_label" class="d-inline word-break " for="id_profile_field_alzrole"> Alzheimer Society Role </label>
<div class="form-label-addon d-flex align-items-center align-self-start">
</div>
</div>
<div class="col-md-9 form-inline align-items-start felement" data-fieldtype="select">
<select class="custom-select
" name="profile_field_alzrole" id="id_profile_field_alzrole">
<option value="<span lang="en" class="multilang">None</span><span lang="fr-ca" class="multilang">Nul</span>" selected="">None</option>
<option value="<span lang="en" class="multilang">Board Member</span><span lang="fr-ca" class="multilang">Membre d'équipage</span>">Board Member</option>
<option value="<span lang="en" class="multilang">ED/CEO</span><span lang="fr-ca" class="multilang">Directeur général/PDG</span>">ED/CEO</option>
<option value="<span lang="en" class="multilang">Manager</span><span lang="fr-ca" class="multilang">Directeur/Directrice</span>">Manager</option>
<option
value="<span lang="en" class="multilang">Programs (e.g. First Link, Education, Support, Soc Rec)</span><span lang="fr-ca" class="multilang">Programmes (par exemple, First Link, Education, Support, Soc Rec)</span>">
Programs (e.g. First Link, Education, Support, Soc Rec)</option>
<option value="<span lang="en" class="multilang">Fund Development</span><span lang="fr-ca" class="multilang">Développement de fonds</span>">Fund Development</option>
<option value="<span lang="en" class="multilang">Volunteer</span><span lang="fr-ca" class="multilang">Faites-vous entendre</span>">Volunteer</option>
<option value="<span lang="en" class="multilang">Other (please specify)</span><span lang="fr-ca" class="multilang">Autre (veuillez préciser)</span>">Other (please specify)</option>
</select>
<div class="form-control-feedback invalid-feedback" id="id_error_profile_field_alzrole">
</div>
</div>
</div>
<div id="fitem_id_profile_field_oalzrole" class="form-group row fitem " style="display: none;">
<div class="col-md-3 col-form-label d-flex pb-0 pr-md-0">
<label id="id_profile_field_oalzrole_label" class="d-inline word-break " for="id_profile_field_oalzrole"> Other Alzheimer Society Role </label>
<div class="form-label-addon d-flex align-items-center align-self-start">
</div>
</div>
<div class="col-md-9 form-inline align-items-start felement" data-fieldtype="text">
<input type="text" class="form-control " name="profile_field_oalzrole" id="id_profile_field_oalzrole" value="" size="30" maxlength="2048">
<div class="form-control-feedback invalid-feedback" id="id_error_profile_field_oalzrole">
</div>
</div>
</div>
</div>
</fieldset>
<fieldset class="clearfix collapsible" id="id_category_1">
<legend class="d-flex align-items-center">
<div class="position-relative d-flex ftoggler align-items-center position-relative mr-1">
<a data-toggle="collapse" href="#id_category_1container" role="button" aria-expanded="true" aria-controls="id_category_1container" class=" btn-icon mr-1 icons-collapse-expand stretched-link fheader " id="collapseElement-1">
<span class="expanded-icon icon-no-margin p-2" title="Collapse">
<i class="icon fa fa-chevron-down fa-fw " aria-hidden="true"></i>
</span>
<span class="collapsed-icon icon-no-margin p-2" title="Expand">
<span class="dir-rtl-hide"><i class="icon fa fa-chevron-right fa-fw " aria-hidden="true"></i></span>
<span class="dir-ltr-hide"><i class="icon fa fa-chevron-left fa-fw " aria-hidden="true"></i></span>
</span>
<span class="sr-only">Your Alzheimer Society affiliation</span>
</a>
<h3 class="d-flex align-self-stretch align-items-center mb-0" aria-hidden="true"> Your Alzheimer Society affiliation </h3>
</div>
</legend>
<div id="id_category_1container" class="fcontainer collapseable collapse show">
<div id="fitem_id_profile_field_regional_society" class="form-group row fitem ">
<div class="col-md-3 col-form-label d-flex pb-0 pr-md-0">
<label id="id_profile_field_regional_society_label" class="d-inline word-break " for="id_profile_field_regional_society"> Your regional Alzheimer Society </label>
<div class="form-label-addon d-flex align-items-center align-self-start">
<div class="text-danger" title="Required">
<i class="icon fa ccn-flaticon-warning text-danger fa-fw " title="Required" role="img" aria-label="Required"></i>
</div>
</div>
</div>
<div class="col-md-9 form-inline align-items-start felement" data-fieldtype="select">
<select class="custom-select
" name="profile_field_regional_society" id="id_profile_field_regional_society">
<option value="" selected="">Choose...</option>
<option value="<span lang="en" class="multilang">Alzheimer Society of Canada</span><span lang="fr-ca" class="multilang">Canada – site internet national</span>">Alzheimer Society of Canada</option>
<option value="<span lang="en" class="multilang">Alzheimer Society of Alberta and Northwest Territories</span><span lang="fr-ca" class="multilang">Alberta et Territoires du Nord-Ouest</span>">
Alzheimer Society of Alberta and Northwest Territories</option>
<option value="<span lang="en" class="multilang">Alzheimer Society of British Columbia</span><span lang="fr-ca" class="multilang">Colombie-Britannique</span>">Alzheimer Society of British Columbia
</option>
<option value="<span lang="en" class="multilang">Alzheimer Society of Manitoba</span><span lang="fr-ca" class="multilang">Manitoba</span>">Alzheimer Society of Manitoba</option>
<option value="<span lang="en" class="multilang">Alzheimer Society of New Brunswick</span><span lang="fr-ca" class="multilang">Nouveau-Brunswick</span>">Alzheimer Society of New Brunswick</option>
<option value="<span lang="en" class="multilang">Alzheimer Society of Newfoundland and Labrador</span><span lang="fr-ca" class="multilang">Terre-Neuve-et-Labrador</span>">Alzheimer Society of
Newfoundland and Labrador</option>
<option value="<span lang="en" class="multilang">Alzheimer Society of Nova Scotia</span><span lang="fr-ca" class="multilang">Nouvelle-Écosse</span>">Alzheimer Society of Nova Scotia</option>
<option value="<span lang="en" class="multilang">Alzheimer Society of Ontario</span><span lang="fr-ca" class="multilang">Ontario</span>">Alzheimer Society of Ontario</option>
<option value="<span lang="en" class="multilang">Alzheimer Society of Prince Edward Island</span><span lang="fr-ca" class="multilang">Île-du-Prince-Édouard</span>">Alzheimer Society of Prince Edward
Island</option>
<option value="<span lang="en" class="multilang">Alzheimer Society of Quebec</span><span lang="fr-ca" class="multilang">Québec</span>">Alzheimer Society of Quebec</option>
<option value="<span lang="en" class="multilang">Alzheimer Society of Saskatchewan</span><span lang="fr-ca" class="multilang">Saskatchewan</span>">Alzheimer Society of Saskatchewan</option>
<option value="<span lang="en" class="multilang">Not Applicable</span><span lang="fr-ca" class="multilang">N'est pas applicable</span>">Not Applicable</option>
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<label id="id_profile_field_society_chapter_ontario_label" class="d-inline word-break " for="id_profile_field_society_chapter_ontario"> Which local Ontario society chapter is nearest you? </label>
<div class="form-label-addon d-flex align-items-center align-self-start">
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<div class="col-md-9 form-inline align-items-start felement" data-fieldtype="select">
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<option value="Brant, Haldimand Norfolk, Hamilton Halton">Brant, Haldimand Norfolk, Hamilton Halton</option>
<option value="Chatham Kent">Chatham Kent</option>
<option value="Cornwall and District">Cornwall and District</option>
<option value="Dufferin County">Dufferin County</option>
<option value="Durham Region">Durham Region</option>
<option value="Grey-Bruce">Grey-Bruce</option>
<option value="Hastings - Prince Edward">Hastings - Prince Edward</option>
<option value="Huron County">Huron County</option>
<option value="Kenora / Rainy River Districts">Kenora / Rainy River Districts</option>
<option value="Kingston, Frontenac, Lennox and Addington">Kingston, Frontenac, Lennox and Addington</option>
<option value="Lanark Leeds Grenville">Lanark Leeds Grenville</option>
<option value="Muskoka">Muskoka</option>
<option value="Niagara Region">Niagara Region</option>
<option value="Ottawa and Renfrew County">Ottawa and Renfrew County</option>
<option value="Peel">Peel</option>
<option value="Perth County">Perth County</option>
<option value="Peterborough, Kawartha Lakes, Northumberland, and Haliburton">Peterborough, Kawartha Lakes, Northumberland, and Haliburton</option>
<option value="Sarnia-Lambton">Sarnia-Lambton</option>
<option value="Sault Ste. Marie and Algoma District">Sault Ste. Marie and Algoma District</option>
<option value="Simcoe County">Simcoe County</option>
<option value="Southwest Partners ">Southwest Partners </option>
<option value="Sudbury-Manitoulin North Bay and Districts">Sudbury-Manitoulin North Bay and Districts</option>
<option value="Thunder Bay">Thunder Bay</option>
<option value="Timmins-Porcupine District">Timmins-Porcupine District</option>
<option value="Toronto">Toronto</option>
<option value="Waterloo Wellington">Waterloo Wellington</option>
<option value="Windsor-Essex County">Windsor-Essex County</option>
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<small><a href="https://alzheimer.ca/on/en/about-us/find-your-local-alzheimer-society#postal_code_search" target="_blank">Find your local society by postal code</a></small>
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<div id="fitem_id_profile_field_society_chapter_quebec" class="form-group row fitem " style="display: none;">
<div class="col-md-3 col-form-label d-flex pb-0 pr-md-0">
<label id="id_profile_field_society_chapter_quebec_label" class="d-inline word-break " for="id_profile_field_society_chapter_quebec"> Which local Quebec local society chapter is nearest you? </label>
<div class="form-label-addon d-flex align-items-center align-self-start">
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</div>
<div class="col-md-9 form-inline align-items-start felement" data-fieldtype="select">
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<option value="Centre-du-Québec">Centre-du-Québec</option>
<option value="Chaudière-Appalaches">Chaudière-Appalaches</option>
<option value="Côte-Nord">Côte-Nord</option>
<option value="Estrie">Estrie</option>
<option value="Gaspésie–Îles-de-la-Madeleine">Gaspésie–Îles-de-la-Madeleine</option>
<option value="Granby et Région">Granby et Région</option>
<option value="Haut-Richelieu">Haut-Richelieu</option>
<option value="Lanaudière">Lanaudière</option>
<option value="Laurentides">Laurentides</option>
<option value="Laval">Laval</option>
<option value="Maskoutains-Vallée des Patriotes">Maskoutains-Vallée des Patriotes</option>
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<option value="Outaouais">Outaouais</option>
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<option value="Suroît">Suroît</option>
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<small><a href="https://alzheimer.ca/federationquebecoise/en/alzheimersocieties#postal_code_search" target="_blank">Find your local society by postal code</a></small>
</div>
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<span class="sr-only">Customize your Notifications</span>
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</a>
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Menu * EducationOpen submenu * HelpOpen submenu * Support Us * Login * Register now! * 416-967-5900 * alzed@alzon.ca * Support dementia education Close submenuEducation * for Everyone * for People living with Dementia / Care Partners * for Health Care Providers * In-Person Education Close submenuHelp * How do I get started? * FAQ * Education * for Everyone * for People living with Dementia / Care Partners * for Health Care Providers * In-Person Education * Help * How do I get started? * FAQ * Support Us * Login/Register * × LOGIN TO YOUR ACCOUNT Don't have an account? Register now! Remember username Lost password? Log in Global searching is not enabled. ALZEDUCATE 1. Home 2. Log in 3. New account Skip to main content NEW ACCOUNT Have an account? Login Collapse all Expand all Username The password must have at least 8 characters, at least 1 digit(s), at least 1 lower case letter(s), at least 1 upper case letter(s), at least 1 special character(s) such as as *, -, or # Password Email address Email (again) First name Surname City/town State/Province Choose... AB BC MB NB NL NT NS NU ON PE QC SK YT AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Other Country Select a country Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia (Plurinational State of) Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo (the Democratic Republic of the) Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czechia Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea (the Democratic People's Republic of) Korea (the Republic of) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia (Federated States of) Moldova (the Republic of) Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Macedonia Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, the United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Tell us about your dementia care role TELL US ABOUT YOUR DEMENTIA CARE ROLE Your role Choose... Health Care Provider Family Caregiver Person with Dementia General Public First Responder Service Sector Alzheimer Society Staff / Volunteer Other Health Care Provider Role None Personal Support Worker Social Worker / Social Service Worker Case Manager RN / RPN OT / PT / OTA / PTA Recreation Other Privately Paid Caregiver Primary Field of Employment Retirement Home Acute Care / Hospital Supportive Housing Long-term Care Community Agency Other None Name of Employer First Responder Role None Fire Paramedic Police Other Service Sector None Recreation Retail Library Restaurant Other Service Sector Position None Staff Temporary employee (contract, intern, co-op student, etc.) Volunteer Board member Leadership (director, owner, manager, supervisor, etc.) Other Society None Alzheimer Society of Canada Alzheimer Society of Alberta and Northwest Territories Alzheimer Society of British Columbia Alzheimer Society of Manitoba Alzheimer Society of New Brunswick Alzheimer Society of Newfoundland and Labrador Alzheimer Society of Nova Scotia Alzheimer Society of Ontario Alzheimer Society of Prince Edward Island Alzheimer Society of Quebec Alzheimer Society of Saskatchewan Brant, Haldimand Norfolk, Hamilton Halton Chatham Kent Cornwall and District Dufferin County Durham Region Elgin-St. Thomas Grey-Bruce Hastings - Prince Edward Huron County Kenora / Rainy River Districts Kingston, Frontenac, Lennox and Addington Lanark Leeds Grenville London and Middlesex Muskoka Niagara Region Ottawa and Renfrew County Oxford Peel Perth County Peterborough, Kawartha Lakes, Northumberland, and Haliburton Sarnia-Lambton Sault Ste. Marie and Algoma District Simcoe County Sudbury-Manitoulin North Bay and Districts Thunder Bay Timmins-Porcupine District Toronto Waterloo Wellington Windsor-Essex County York Region Abitibi-Témiscamingue Bas-Saint-Laurent Centre-du-Québec Chaudière-Appalaches Côte-Nord Estrie Gaspésie–Îles-de-la-Madeleine Granby et Région Haut-Richelieu Lanaudière Laurentides Laval Maskoutains-Vallée des Patriotes Montréal Outaouais Québec Rive-Sud Saguenay-Lac-Saint-Jean Suroît Other Dementia Care Role Alzheimer Society Role None Board Member ED/CEO Manager Programs (e.g. First Link, Education, Support, Soc Rec) Fund Development Volunteer Other (please specify) Other Alzheimer Society Role Your Alzheimer Society affiliation YOUR ALZHEIMER SOCIETY AFFILIATION Your regional Alzheimer Society Choose... Alzheimer Society of Canada Alzheimer Society of Alberta and Northwest Territories Alzheimer Society of British Columbia Alzheimer Society of Manitoba Alzheimer Society of New Brunswick Alzheimer Society of Newfoundland and Labrador Alzheimer Society of Nova Scotia Alzheimer Society of Ontario Alzheimer Society of Prince Edward Island Alzheimer Society of Quebec Alzheimer Society of Saskatchewan Not Applicable Which local Ontario society chapter is nearest you? Choose... None Brant, Haldimand Norfolk, Hamilton Halton Chatham Kent Cornwall and District Dufferin County Durham Region Grey-Bruce Hastings - Prince Edward Huron County Kenora / Rainy River Districts Kingston, Frontenac, Lennox and Addington Lanark Leeds Grenville Muskoka Niagara Region Ottawa and Renfrew County Peel Perth County Peterborough, Kawartha Lakes, Northumberland, and Haliburton Sarnia-Lambton Sault Ste. Marie and Algoma District Simcoe County Southwest Partners Sudbury-Manitoulin North Bay and Districts Thunder Bay Timmins-Porcupine District Toronto Waterloo Wellington Windsor-Essex County York Region Find your local society by postal code Which local Quebec local society chapter is nearest you? None Abitibi-Témiscamingue Bas-Saint-Laurent Centre-du-Québec Chaudière-Appalaches Côte-Nord Estrie Gaspésie–Îles-de-la-Madeleine Granby et Région Haut-Richelieu Lanaudière Laurentides Laval Maskoutains-Vallée des Patriotes Montréal Outaouais Québec Rive-Sud Saguenay-Lac-Saint-Jean Suroît Find your local society by postal code Customize your Notifications CUSTOMIZE YOUR NOTIFICATIONS I would like to receive Alzheimer Society updates (i.e. education/ learning opportunities, newsletter, etc) I give my permission to be contacted by an Alzheimer Society staff member to learn about more Alzheimer Society supports and services. I give my permission to be contacted by an Alzheimer Society staff member to learn more about dementia-friendly communities Your mailing address YOUR MAILING ADDRESS Security question Required CONTACT US * Alzheimer Society of Ontario 20 Eglinton Avenue West, 16th floor, Toronto, Ontario M4R 1K8 * Tel: 416-967-5900 * Email: alzed@alzon.ca * Charitable Registration Number: 11878 4842 RR0001 EDUCATION * for People living with Dementia / Care Partners * for Health Care Providers * for Everyone * In-person education HELP * How Do I Get Started? * Frequently Asked Questions * Refund Policy * Privacy Policy SUPPORT ALZEDUCATE * Donate * * * * Copyright © 2023 Alzheimer Society of Ontario. All Rights Reserved. Close menu