Alzheimer's Association - Greater Illinois Chapter

Monthly Support Group Meeting Report

City Where Group Meets:

County:

Date / Time of Meeting:

Group Facilitator(s):

Total Number of Attendees:

Number of First Time Attendees:

No Attendees This Month:

Group Cancelled:

Facilitator Notes/Comments (If you had a speaker, please list speaker and topic):

Facilitator: Please list any changes in your contact information:

Facilitator: If you plan to make a permanent change to your group’s location and/or meeting time, please list that information below. (NOTE: DO NOT FILL THIS SECTION OUT UNLESS YOUR GROUP INFORMATION IS CHANGING)

New Attendees, or Change of Attendee Contact Information:

CONTACT

CHANGE/ADD

LOCATION

PHONE

Name
Email

Address
City
Zip

Day
Evening

Name
Email

Address
City
Zip

Day
Evening

Name
Email

Address
City
Zip

Day
Evening

Name
Email

Address
City
Zip

Day
Evening

Name
Email

Address
City
Zip

Day
Evening

Submitted By:		Date:
Email address: