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Consortium
African countries
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Surname
First Name
Middle Name
Nationality
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d’Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor-Leste)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Fiji
Finland
France
Gabon
The Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia, Federated States of
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
North Macedonia
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Gender
Male
Female
Others
Do not wish to indicate
Email Address
Phone Number
Country of Residence
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d’Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor-Leste)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Fiji
Finland
France
Gabon
The Gambia
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia, Federated States of
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
North Macedonia
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
State/Region/Province
City
Occupation/Position
Researcher
Clinician
Public Health Professional
Other
Occupation/Position - Other (Please specify)
Institution/Organization Name
Department/Unit
Years of Experience
LinkedIn Profile or Professional Website
What is your current career stage? (Please select the option that best describes your current level of experience)
Early Career Researcher (ECR): Within 10 years of obtaining a PhD or equivalent qualification, including postdoctoral researchers.
Mid-Career Researcher: An independent researcher with several years of research experience and publications.
Senior Researcher: An advanced researcher, typically holding leadership roles such as professor or principal investigator.
Clinician Researcher: A medical professional involved in clinical care and dementia research.
Student/Graduate Researcher: Currently enrolled in an undergraduate, master’s, or PhD program with an interest in dementia research.
Industry Professional: Engaged in dementia-related research in the private sector or industry.
Other
Current Career Stage - Other (Please specify)
What is your primary discipline or area of expertise? (Please select the field that best represents your expertise. Multiple fields can be selected, If none applies, please select "Other" and specify)
Neuroscience
Genetics/Genomics
Psychiatry
Neurology
Geriatrics
Public Health
Epidemiology
Clinical Psychology
Cognitive Science
Pharmacology
Nursing
Social Work
Medical Anthropology
Sociology
Health Policy
Economics
Health Informatics
Data Science
Artificial Intelligence (AI)/Machine Learning
Bioinformatics
Ethics & Bioethics
Law (Health Law, Human Rights, etc.)
Caregiving Research
Rehabilitation Science (Physical/Occupational Therapy)
Speech and Language Pathology
Education (Cognitive or Special Needs)
Health Communication
Technology/Engineering (Medical Devices, Assistive Tech)
Other
Primary Discipline/Area of Expertise - Other (Please specify)
Areas of Interest within Brain Health and Dementia Research
Epidemiology
Economics
Biobanking
Bioinformatics
Genetics/Genomics
Multi-Omics
Biomarkers
Disease Mechanisms
Models
Artificial Intelligence
Machine Learning
Data Science
Dementia Diagnosis
Drug Discovery
Clinical trials
Dementia Care
Risk Reduction
Patient Engagement
Public Engagement
Social Determinants of Health
Other
Areas of Interest - Other (Please specify)
What role do you (or would you like to) play in the consortium?
Principal Investigator
Co-Investigator
Project Manager
Research Coordinator
Researcher Assistant
Collaborator
Consultant
Advisor
Advocate
Volunteer
Postdoctoral Researcher
Postgraduate Student
Trainee
Undergraduate Student
Other
Role - Other (Please specify)
Please describe how you would like to contribute to the consortium’s goals
Do you agree to have your information stored and used for consortium-related communication and activities?
Yes
No
Would you like to subscribe to the consortium's newsletter or updates?
Yes
No
Feedback or additional information
I certify that the information provided is accurate to the best of my knowledge.
I agree to the consortium’s terms and privacy policy.
Date
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