Volunteer for Research Form

We sincerely appreciate your interest in learning more about the Memory and Aging Project. We are seeking adults age 55 or older with normal memory and also those with mild memory changes to participate in our longitudinal research. Please complete the secure, private form below and a research coordinator will contact you to discuss research participation.

About You:

First Name:

A value is required.
Last Name: A value is required.
Street Address: A value is required.
City: A value is required.
State: Please select an item.
Zip Code: A value is required.Minimum number of characters not met.


Daytime/Cell Number: A value is required.
Email Address: A value is required.


How did you hear about us? Check all that apply.

Please provide details for your selections immediately above:

Optional information, but very helpful for our follow up:

Current Age:


Are you concerned about your memory?


Please explain:

Do you or have you had a parent affected by cognitive impairment?


Privacy, Confidentiality, and Security


Washington University School of Medicine protects your private health information and complies with all state and federal privacy laws.  Your information will not be shared or provided for any use outside of the Knight Alzheimer Disease Research Center.  Any personal information collected on this site will use a Secure Socket Layer (SSL) protocol which ensures your information is securely stored and transmitted.


If you have questions about participating in research, or would like to know more about how we safeguard your privacy, please call the Knight Alzheimer Disease Research Center at 314-286-2882.