Your details

Title

First name

Surname

Email address

Phone number

Postcode

Address line 1

Address line 2

Address line 3

Town

Country

Are you over 18?

Your fundraising

Please tell us what best describes your connection to dementia

How much do you plan to raise?

Would you like a free fundraising pack in the post?

Would you like an event vest or top?

Vest type

Size

Vest letters

Please tell us what name you’d like on your top, (if any - maximum 10 letters)

It’s only with support from people like you that we can give more people affected by dementia the life-changing care that they need.

We will update you via post on the huge difference you are making to families living with dementia and how you can support us in the future.

If you would prefer not to hear from us, please let us know:

No post please

Please let us know if you’re also happy to hear from us

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If you have previously subscribed to receive information from us, your answers above will update your settings.

You can change how we contact you at any time by contacting our Supporter Care team on 0300 365 5500, email supportercare@dementiauk.org or update your preferences here.