Create a Memorial

A Memorial Page can be set up to pay tribute to your loved one who has passed away and will be a lovely way to remember them.

In setting up your unique online Memorial Page, you will be able to share your thoughts and memories of your loved one and upload an image for your Page.

Once you have completed and submitted your form, you will be sent your unique link to share with your family and friends.

Those who wish to donate can directly access the Memorial Page using the link, this will enable them to donate to ADSS (Alzheimer’s and Dementia Support Services) in memory of your loved one.

If you need any help in completing the form, please call Ese on 01474 533990 who will be happy to assist, or email info@alz-dem.org.

Name of who you are remembering

A description of what they meant to you and how you would like them to be remembered

Date of Birth (DD/MM/YYYY)

Date of Death (DD/MM/YYYY)

Date of Funeral (DD/MM/YYYY)

Which appeal would you like to fundraise for?

Please upload a great picture for the top of your page.

First Name

Last Name

Phone

Keeping In Touch

We'd love to keep you posted with our news, activities and how you can help in other ways. We'll never sell or swap your details with anybody else. You are free to change your mind at anytime. Please indicate how you would like to hear from us by using the tick boxes below

Via email Via telephone Via post

Your Privacy

We will always store your personal details securely. We'll use them to provide the service that you have requested, and communicate with you in the way(s) that you have agreed to. Your data may also be used for analysis purposes, to help us provide the best service possible. For full details see our Privacy Policy

By submitting this form you are agreeing to our terms and conditions

01474 533990