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Dahlias for Dementia Booking Form

All proceeds from Dahlias for Dementia go to the Maungaturoto Community Charitable Trust towards a new dementia unit in Kaipara District. Alzheimers Northland are showing their support by offering their website as a booking service.

Use this form to book your tickets and your optional pre-order lunch which can be picked up from 10am to 2pm.

Lunch Option 1 = Tuscan Roast Pork seasoned with garden herbs in a locally baked ciabatta bun, seasonal fresh fruit salad and a fresh-baked sweet item.

Lunch Option 2 = Kaipara Kumara Salad, seasonal fresh fruit salad and a fresh-baked sweet item (GF, Vegetarian. Vegan or dairy free on request - please email or phone)

Amount *	Quantity
$50 - FULL PRICE
$20 - Lunch Option 1 for Saturday 22nd
$20 - Lunch Option 2 for Saturday 22nd
$20 - Lunch Option 1 for Sunday 23rd
$20 - Lunch Option 2 for Sunday 23rd

Contact Information

Name

First Name

Last Name

Verify Email

Phone

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Privacy

Your information is used for ticket purchase purposes by Alzheimers Northland and Dahlias for Dementia to enable us to communicate effectively with you. The information you give to us is held in a secure database which is accessed and managed only by those with authority to do so. We will not share your information with companies or organisations. We make every effort to keep your details up to date, and you may ask us to correct those details at any time. If you no longer wish to receive correspondence from us, we will remove your details from our mailing list. You can email us at northland@alzheimers.org.nz or phone 0800 004 001 If you would like to receive email news letters please tick below...

I agree to receive emails from Alzheimers Northland

We use Paypal to process your payment. You can pay by credit card or debit card without signing into a paypal account by choosing the option "Pay by Debit or Credit Card"

Please note that your receipt will come from Alzheimers Northland however all monies will be passed on to The Maungaturoto Community Charitable Trust.

You will receive your ticket by email immediately after purchase. If no email arrives please check your spam.