Refer a friend

Refer a friend or family member to join research study today and you will receive a $55 Visa gift card when they enroll.

Pick a friend or a family member who is new to Charter Research.

Fill out the form below.

Fill Out The Form

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Refer a friend or family member to join a research study today and you will receive a $55 Visa gift card when they enroll.

Pick a friend or a family member who is new to Charter Research, then fill out the form below.

About You

First Name*

Last Name*

Your Email Address*

Your Phone Number*

About the Person You're Referring

Their First Name*

Their Last Name*

Their Phone Number*

Which Charter Research location is closer to your friend?

Choose a location*

Comments (not required)

Comments

_______________________________________________

Refer another friend?

Refer friend #2

Yes

Their First Name*

Their Last Name*

Their Phone Number*

Which Charter Research location is closer to your friend?

Choose a location*

Comments (not required)

Comments

_______________________________________________

Refer another friend?

Refer friend #3

Yes

Their First Name*

Their Last Name*

Their Phone Number*

Which Charter Research location is closer to your friend?

Choose a location*

Comments (not required)

Comments

_______________________________________________

Refer another friend?

Refer friend #4

Yes

Their First Name*

Their Last Name*

Their Phone Number*

Which Charter Research location is closer to your friend?

Choose a location*

Comments (not required)

Comments

_______________________________________________

Refer another friend?

Refer friend #5

Yes

Their First Name*

Their Last Name*

Their Phone Number*

Which Charter Research location is closer to your friend?

Choose a location*

Comments (not required)

Comments

Street Address

This field is for validation purposes and should be left unchanged.

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As we partner together, we find lasting solutions.

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Join Our Newsletter

Join our newsletter to receive the latest news on our journey to cure Alzheimer’s disease. As we partner together, we find lasting solutions.

Join our newsletter to receive the latest news on our journey to cure Alzheimer’s disease.

As we partner together, we find lasting solutions.