Darrell K Royal Reasearch Fund for Alzheimer's Disease

Apply for the Legacy Council below:

Username

First Name *

Last Name *

Legacy Council Fundraising Goal *

(Minimum of $1000)

Email *

Telephone

Address

City

State

Zip

Company/Employer

Referred By

Other Referral

If other, please specify who referred you here:

For your fundraising page, please provide one (or two) narrative blocks describing your affiliation to U.T., Coach Royal, and/or Alzheimer’s Disease.

Narrative Block 1

This will be shown on your fundraiser page.

Narrative Block 2

This will be shown on your fundraiser page.

NOTE: You will have an opportunity to upload a photo for your profile once your application has been approved.

Please enter an answer in digits:

sixteen + 9 =

Registration confirmation will be emailed to you.

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