Create a tribute page to raise funds in memory of your loved one.

Please complete the below form with the information for your page and a member of our team will advise you once it is ready.

Account details

Please enter the details of the person who will manage the page. This may include logging in to make changes once the page is set up.

Title* First name* Last name* Email address* Phone* Postal address*

Formatted Address

Memorial page details

Fundraising target (optional) In memory of*

Tell everyone why you are raising money for Epworth Medical Foundation. This will appear on your personal page. You are welcome to use the below, or edit it as you wish.

If left blank, will read:
I want to honour and celebrate their memory by raising money for the Epworth Medical Foundation (EMF).
EMF raises essential funds to provide exceptional care for patients at Epworth, a not-for-profit, private hospital group. Your support goes to world-class medical equipment, innovative research and compassionate patient programs.
Please help me support EMF by making a gift. The more people that know about this fundraiser, the greater the impact, so please also spread the word by sharing this page.
Thank you in advance for your generosity.

Would you like to upload a photo of your loved one to the page? Which area do you want to fundraise for?* (Please select one) If other please specify

If you would like to discuss your memorial page in further detail, please contact 03 9426 6132 or [email protected]

I agree to the terms and conditions below* Epworth Medical Foundation Community Charter (PDF, 137KB)
EMF Privacy Collection Notice
Epworth Privacy Policy