Wall of Gratitude Request Form

To begin the process of ordering your butterfly, please fill in the details below. A member of our team will then be in touch with you with more details on how to proceed before your order is complete. Note this form will not take any payment for the butterfly.

Eircode (your Eircode has 7 characters)
Eg. +353 87 1234567 or +353 21 7654321

Would you like us to keep you updated about the fundraising appeals of the Mercy? Tick or untick the boxes as you wish.

(we have just two mail campaigns a year)
(we will never ring you more than three times a year)
(we can send you our monthly e-zine with updates, stories and more)