You don't have javascript enabled. Please enable Javascript on this website.
These fields are mandatory
There was a problem submitting your form
Please review the highlighted fields below
Please tell us more about the person you’re donating in memory of. We may use this information to tailor our communications with you. We will keep this information strictly confidential.
Please tell us a bit more about your special occasion. We may use this information to tailor our communications with you. We will keep this information strictly confidential.
I am donating in celebration of:
Your £12 donation turns into £15 by adding Gift Aid!
Add 25p of Gift Aid for every £1 you give at no extra cost to you!
I will update Alzheimer's Society if my address or tax circumstances change in the future. Alzheimer’s Society will reclaim 25p of tax on every £1 I give.
We'll send your confirmation email to this address
Please enter your UK address. Alternatively, use our postcode lookup.
If your live outside the UK, or does not appear upon lookup, please enter it manually.
In order to set up a Direct Debit instruction online you must be:
By continuing, you are confirming this to be the case. Alternatively, you can download and use our Direct Debit postal form.
Please select from the available dates below to commence your direct debit support.
We can only win the fight against dementia through the passion and generosity of our valued supporters. We’d love to stay in touch and keep you updated about everything we’re doing, including fundraising, our campaigning work, services, research and volunteering. We will never sell your data on to third parties. Please let us know how you would like to keep up to date, thanks.
Yes, I’d like to stay in touch via email so I can keep up to date when it suits me
Yes, I’d like to stay in touch via social media so I can keep up to date when it suits me
Yes, I’d like to stay in touch via SMS so I can get updates straight to my mobile
Yes, I’d like to stay in touch via phone so I can hear from a real person
No contact via post, please