Dementia UK : Register

Which fundraising pack would you like? *

Personal Details

First Name *

Last Name *

Email Address *

Password*

Mobile Number

We’ll be in touch to support your Time for a Cuppa event. You won’t be contacted further by the charity unless you opt-in to hear from us below.

Please tell us what best describes your connection to dementia *

Do you work for our sponsor, Nationwide Building Society? *

Postal Address *

(enter manually)

Address Line 1 *

Address Line 2

Town/City *

Postcode *

County

Country *

Date & Location

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 your Time for a Cuppa?

Organisation Details

If you’re taking part with an organisation, please let us know below

Organisation Name

Are you over 18? *

Yes

No

Stay in touch?

Please let us know if you would like to hear from us about the huge difference you are making to families living with dementia and how you can support us in the future:

Email

Phone

SMS

Post

By registering for the challenge, you agree to Dementia UK Terms and Conditions. For information about how we use and protect your data please see our privacy notice. If at any time you would like to stop receiving communications from Dementia UK, or make any changes to how we contact you, please email supportercare@dementiauk.org or call us on 0300 365 5500.

Complete your Time for a Cuppa registration

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