Events – Matinée

Name*

First Last

Email*

Please provide an email address so we can send you confirmation of your tickets, your welcome letter and venue information.

Phone*

Number of tickets for people living with dementia/memory challenges.*

Number of tickets for carers, family members and friends.*

Total number of tickets

Wheelchairs/Mobility Scooters*

Please let us know the number of wheelchairs or mobility scooters you will be bringing so that we can make sure you have a choice of where to sit.

Relationship between carer and person with dementia*

e.g. partner/spouse/ child/ parent/ etc.

Dementia Diagnosis: when was the diagnosis given?*

0-2 years ago
2-5 years ago
5 years ago
None

Living at home?*

Yes
No

How did you hear about Matinée?*

Have you been to a Matinée screening before?*

Yes
No

Transport: do you need transport to get the screening?*

Yes
No

We can put you in touch with a local transport scheme to help you get to screenings. Some financial support may be available to help you access this. Please make sure your contact details are correct.