Creating your Personal Tribute Fund

All we need are a few key details to set up your fund.

Please complete the boxes below and submit. We will email you back when the Fund has been created and provide you with its unique Tribute Fund reference number. We aim to do this promptly but please allow up to two working days.

Fields marked with a * must be completed.

In Honour of The name of the person you wish to honour *

Current/Last Address of this person *

Postcode

Country *

Your Relationship to them (eg Wife, husband, partner, daughter etc.)

Is the fund in honour of someone who has passed away? *
Yes No

Your details Your Title (Dr, Mr, Mrs, etc) *

First Name *

Surname *

Address (line 1) *

Address (line 2)

Address (line 3)

Address (line 4)

Town *

County *

Postcode *

Country *

Telephone Number

Email Address*

Will you be taking your Fund "online"?
Yes No

Data Protection

The MND Association complies with the Data Protection Act. Your details will be added to our database. You may inform us at any time if you do not wish to receive mailings from the MND Association or the organizations with whom we co-operate.