Tea Day Form

Name & Email

First Name*

Last Name*

Enter Email*

Enter Email * Confirm Email *

Phone Number

Address

Country*

Address 1*

Address 2*

Address 3

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. Find out details

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 policy Privacy Statement and Supporter Promise

Please send me a*

Standard pack (Posters, coin boxes and raffle tickets x 2. Balloons and an invitaiton booklet.)

Large pack (Postersx 6, coin boxes and raffle tickets x 6, Balloons and raffle ticket x 10)

I don't need a pack

Date of Event*

How did you hear about Tea Day?*