Dine 4 Dementia Form - Jewish Care

We will provide you with resources, tools and tips to maximise your fundraising. If you are under 18, please ask an adult to fill in this form.

Age

I confirm I am over 18 years of age*

Name(Required)

Title First Last

Phone number(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 Town / City Postcode Country

How did you find out about our 'Dine 4 Dementia' campaign?(Required)

Date of dining event(Required)

Would you like us to create a donation page for you on the Jewish Care website?(Required)

Yes

No

A donation page is a way for your friends and family to donate to your fundraiser online. You will be able to share a link with them so that they can access it directly. It may take up to 7 working days for your donation page to become live on our website. We will send you an email to confirm when the page is live so that you are able to share the link with others.

If yes, please provide a short message to display for your friends and family

Upload a photo/image for your donation page

Accepted file types: jpg, pdf, Max. file size: 8 MB.

If no photo is uploaded, a generic image will be used. By uploading your photos and images, you agree for Jewish Care to use them on our website for your celebration.

Consent

Please tick here if you are happy for Jewish Care to use the photos and images you share with us for future marketing purposes, which may include use on our website, social media and in press.

We will send you information by post to tell you about our work and how you can help us through financial support, by taking part in events or by volunteering. Please tick here if you are happy to receive this information by:

You are in control of how we use the information you share with us. If you would like to change the way you hear from us or no longer wish to receive communications from us, you can let us know by contacting our Supporter Care Team on 020 8922 2600 or by emailing supportercare@jcare.org To find out more about your rights and how we process your personal information visit privacy statement or ask our Supporter Care Team for a copy of our privacy statement.

Email

Phone

Text message

Comments

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