First Name *

Last Name *

Email *

Your address

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Address line 1 *

City / Town *

Postcode *

County *

Country *

Organisation name

If you're fundraising as part of an organisation/company, please let us know the organisation name.

Please tell us your connection to our work: *

I am a parent or guardian of a baby born premature or sick

I am a friend or family member of someone who had a baby born premature or sick

I am a bereaved parent

I am a neonatal healthcare professional

I am a healthcare professional, but don't work directly in neonatal care (e.g. a midwife or GP)

I was born premature or sick

Other

If other, please give details

Your fundraising

How are you planning to fundraise? *

Please tell us about the event or activity you are planning, so we can support you in your fundraising.

Date of your event or activity

If you know the date your fundraising event or activity will take place, let us know.

Let's keep in touch

Your support helps the most vulnerable babies in the UK. We’d love to keep you updated with news about our work and ways you can get involved with Bliss.

Yes, I’d like to hear from you by email

Yes, I’d like to hear from you by phone

Yes, I’d like to hear from you by text

Your privacy

We (Bliss and Bliss Scotland) promise to keep your details safe and never pass them on to third parties for marketing purposes. Find out how we look after your personal data in our Supporter Promise. If you have provided a postal address we may occasionally contact you by post, but you can opt out of all communications from Bliss at any time by calling us on 020 7378 1122 or emailing us.

Register your World Prematurity Day fundraiser

Your fundraising

Let's keep in touch

Your privacy