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Thanksgiving Thistles Form
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1) Your Personal Details
Title
Name
*
First
Last
Address
*
Address Line 2
Town/City
*
County
Postcode
*
Country
Phone
Email
*
2) I/We would like to dedicate a Thanksgiving Thistle at St Andrew’s Hospice this summer.
Would you like to dedicate a Thanksgiving Thistle to someone special?
Yes
No
3) Please tell us the name you’d like us to inscribe on a Thanksgiving Thistle.
You can send more than one name if you wish, please just write the other name(s) in the 'Additional name(s)' box below.
Name
*
First
Last
Additional name(s):
4) Please tell us if you think you’ll be coming to the event.
Do you plan on attending the Thanksgiving Service at St Andrew's Hospice on Thursday 18th August at 7pm?
*
Yes
No
Please could you tell us how many people are likely to be in your family or group?
If you are unable or unlikely to attend, would you like us to send your Thanksgiving Thistle back to you:
Before the service
After the service
5) Please make a donation towards St Andrew’s Hospice care
Please choose your gift:
£21.45 - is enough to provide complementary therapy oils for two patients attending our Wellbeing service.
£42.68 - a gift which could pay for 6 children’s support workbooks to support young people through the loss of someone precious.
£77.14 - could pay for 7 days’ worth of meals for a patient in our inpatient unit.
£104.40 would pay for 5 hours of physiotherapy to help a patient manage their mobility.
Your own preferred gift amount
Your gift:
Gift Aid
*
Yes
No
I confirm I authorise St Andrew's Hospice to treat all donations I have made for the four years prior to this / today / any future donations until I notify you otherwise as gift aid donations. I confirm I have paid or will pay an amount of UK income tax and/or capital gains tax for each tax year 6th April to 5th April that is at least equal to the amount of tax that all the charities or CASC that I donate to will reclaim on my gifts for that tax year. I understand that other taxes such as VAT and council tax do not qualify. I understand the charity will reclaim 25p on every £1 that I give.
What is Gift Aid?
Total
£ 0.00
Payment Card Details:
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6) Staying in touch
Please select the ways we can keep in contact with you:
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We really value your support and would like to stay in touch to keep you up to date on the work of St Andrew's Hospice including our events and fundraising activity. We will never sell or share information with other charities or organisations for marketing purposes not related to St Andrew's Hospice.
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