Complete your Time for a Cuppa registration

Which fundraising pack would you like?

Tell us about yourself

Title

Name*

First name Last name

Email*

Phone

Organisation name (if applicable)

Date of birth*

By providing your date of birth, you help us to identify and protect young fundraisers.

Please tell us what best describes your connection to dementia

Tell us your address*

This is where we’ll send your fundraising pack

Address Line 1 Address Line 2 City Postcode

Do you work for our sponsor, Nationwide Building Society?

Yes
No

Tell us about your event

When are you hosting your Time for a Cuppa?

(if you’re not sure, don’t worry – just let us know as soon as you have a date sorted)

Where are you hosting Time for a Cuppa?*

Who would you like your thank you certificate to be addressed to?

Keeping you updated

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 contact via post please

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

By email*

Yes
No

By text*

Yes
No

By telephone*

Yes
No

If you have previously subscribed to receive information from us, your answers above will update your settings. Dementia UK are committed to protecting your personal data. Please view our full privacy notice at www.dementiauk.org/privacy-notice. If you would like to change how you are contacted by us, simply contact our Supporter Care team 0300 365 5500 or email supportercare@dementiauk.org

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