Donate - Alzheimer

Give today for a better tomorrow

How often would you like to donate?

Give Once

Give Monthly

How much would you like to give?*

*Tax Efficient Giving - If you donate €250 or more in a year we can reclaim tax and help even more people living with dementia, at no extra cost to you.

My own amount*

Your Donation

Hidden

Donation Amount

What inspired your donation?

I would like to give in memory of a loved one.

Would you like us to send the next of kin an ASI In Memory Card, letting them know that you have made a special donation in memory of their loved one.

Name of loved one

Next Of Kin Name (First & Last Name)

Next to Kin Address

Name & Email

First Name*

Last Name*

Email Address*

Enter Email * Confirm Email *

Phone Number

Address

Country*

Address 1*

Address 2 (optional)

Address 3 (optional)

Town

County*

Eircode

Communication / Keep In Touch

We hope you'll be proud of the work The Alzheimer Society of Ireland do and you're making happen. We would love to keep you updated about our work and let you know how you can continue to help support our services.

Keeping you informed

Email

Phone

Please indicate how you would like to stay in touch (you may choose more than one)

You can unsubscribe from receiving ASI communications at any time.

You can withdraw your consent at any time by contacting us at [email protected]

We will never share your data with a third party.

We may also keep you updated by post; you can object to postal marketing at any time by contacting us at [email protected]

For further information please see our Privacy Statement and Supporter Promise

Payment type*

My monthly Gift
by
Credit/Debit Card

My monthly Gift
by
Direct Debit

Payment type Give Onces*

My single gift by Credit / Debit Card

Payment

Make a monthly donation by SEPA Direct Debit

Please complete and submit this form to set up a paperless monthly direct debit using SEPA Direct Debit.

When we receive this form we will send you a confirmation letter indicating the details of your direct debit donation with Alzheimer Society of Ireland. You will also receive an email immediately acknowledging receipt of this form.

The information you have provided will be kept securely and used by Alzheimer Society of Ireland in order to make your monthly donation possible. Your information will only be shared with selected third party service providers, contracted by Alzheimer Society of Ireland to assist with our campaigns. Your information will not be shared any other organisation, other than with your permission, or where required by law.

IBAN Number*

Your IBAN begins with IE

BIC Number*

Your BIC begins with 6 letters

Account Holders Name*

Is bank account a Republic of Ireland account?

Yes

No

Is more than one signatory required to sign on your account?

Yes

No

Paperless SEPA Direct Debit cannot be set up for dual signatory bank accounts

Can this bank account accept Direct Debits?*

Yes

No

Creditors Identifier Number (CI) : IE62SDD306600

Credit Card

Card Details

Cardholder Name

Donation

Comments

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