To print this page click the PRINT icon on your browser. This page represents a printable version of the following page: http://www.lrf.org.uk/en/1/funfmnform.html Set up a Forget Me Not fund online Setting up a Forget Me Not fund online Thank you for deciding to set up a Forget Me Not Fund in honour of your loved one; the contribution your fund makes will be vital for our much needed work. Your fund will be set up as soon as we receive your completed form. If it is more convenient for you to complete the form over the telephone please call us on 020 7269 9091. Title: MrMissMrsMs Forename: * Surname: * Email Address: * Address 1: * Address 2: Town: * County: * Postcode: * Telephone: Name of the person honoured by the Forget Me Not Fund Title: MrMissMrsMs Forename: * Surname: * Relationship to you: Is there anything else you would like us to know about your loved one, or that you feel we should be aware of? How did you hear about the Forget Me Not funds? Please select: Leukaemia Research websiteThird party websiteSearch engineLeukaemia Research branchLeukaemia Research newsletterLeukaemia Research supporterLeukaemia Research sporting eventFriend/ family/ colleagueFuneral directorNewspaperRadioMagazineOther, please specify below Other: We would love to keep you informed of our work and how your support is helping cancer patients. Please tick box if you would prefer NOT to receive any information If you are happy to receive information, tick box(es) to let us know if we may, in addition to posting materials: Email you and/or Telephone you   Mandatory fields are marked with an asterisk (*)

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