Regular giving cancellation feedback form

Title (required)

First name (required)

Surname (required)

Email (required)

(optional)

Address (required)

If preferred, enter or amend your address below.

Address line 1 (required)

Address line 2 (required)

Town or city (required)

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Postcode (required)

Daytime Telephone Number (required)

Why have you decided to stop regular giving? *

I have stopped my regular gift because: (required)

Why did you choose to support us? *

Please write down why below, if you’re happy to share this: (required)

What do you think of the frequency we send you information about Alzheimer’s Society? (required)

Do you support other charities regularly? (required)

Tick this option to receive our free guide to Gifts in Wills

Are you interested in leaving a gift in your will? (required)

Any other thoughts? (required)

We’d love to stay in touch and keep you updated about everything we’re doing, including fundraising, our campaigning work, services, research and volunteering. We will never sell your data on to third parties. Please let us know how you would like to keep up to date, thanks. *

Yes, I’d like to stay in touch via SMS so I can get mobile phone updates (required)

Yes, I’d like to stay in touch via phone so I can hear from a real person (required)

No, contact via post, please (required)

Regular giving cancellation feedback form

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