Samaritans Ireland Fundraising Form

Thank you for choosing to support Samaritans' life-saving work in Ireland & Northern Ireland.

Please fill out this form so we can help you with your amazing fundraising!

Name (required)

Email (required)

Mobile Number (required)

Address (required)

Date of event (if known)

Day

Month

Year

Location (if known)

Is this a corporate fundraiser (associated with a business/workplace)? (required)

Yes this is a corporate fundraiser

No it is something else

Please provide a brief summary of the event you intend organising (required)

Please tell us your reason for supporting Samaritans

We'd love to hear why you’re organising this fundraiser, or the inspiration behind it – feel free to share your story with us if you wish.

How can we support you? (required)

Please let us know what materials (bunting, t-shirts, pens, bracelets, information sheets on Samaritans services, balloons etc.) you might need before the event and if you need any help with the promotion.

Please specify if you would like funds raised from this event to go to a specific branch by selecting it from below:

Captcha (required)