Memory Tree

"*" indicates required fields

Step 1.

TITLE*

FIRST NAME*

LAST NAME*

PHONE NUMBER*

Email*

ADDRESS 1*

ADDRESS 2

CITY*

POSTCODE*

COUNTRY*

YOUR REASON FOR DONATION

Written Consent

I would like to receive written confirmation of my donation

Step 2.

Leaf Details

COLOUR*

DISPLAYED FOR*

NAME TO APPEAR ON LEAF*

Gift Aid

Add 25p for every £1 you give – at no extra cost to you! It only takes a tick!

Gift Aid

Yes

I want to Gift Aid my donations to St Leonard’s Hospice, including any I make in the future, or have made in the past four years until I notify you otherwise. I am a UK taxpayer and I understand that, in any tax year, if the total of my Income Tax and Capital Gains Tax due is less than the amount of Gift Aid claimed on all my donations, it is my responsibility to declare this to HMRC.

Step 3.

Your communication preferences

We would love to keep you updated on the Hospice’s work, events and fundraising activities. Please tick to confirm your consent and preference:

Email Consent

Yes, I want to receive updates by email

Text Consent

Yes, I want to receive updates by text

We may also occasionally contact you by post and / or phone, but you can tick the box below to say you’d prefer us not to:

Post Consent

No thanks, please don’t send me updates by post

Phone Consent

No thanks, please don’t send me updates by phone

Under 16

Please tick if you are 16 or under (we can still keep you updated but we will need your parent/guardian’s permission. We will post you a form for them to sign)

Gifts in Will

Please send me information about Gifts in Wills

Step 4.

Credit Card*