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Light
Up A Life with Phyllis Tuckwell Hospice
NAME:……………………………………………….
ADDRESS: ……………………………………………………………………..
POSTCODE: ……………………………………….
DAYTIME TEL: ………………………………………
I
would like to make a donation to the Phyllis Tuckwell Hospice and to Light
Up A Life in memory of: (please print name)
………………………………………………………………………….....
……………………………………………………………………………..
……………………………………………………………………......……
I hope to attend the special service for Light Up A Life at the Hospice on
Monday 10th December
...................................................................................
...................................................................................
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Please tick this box if you would rather not receive an acknowledgement
for your gift. This will help save on our administrative costs.
Please return this
form by Friday 30th November to allow us to include the name of
your friend or relative in our book of remembrance.
Please accept my
donation of £………………….
I
wish to pay by (please tick as appropriate)
Cheque
(please make cheques payable to Phyllis Tuckwell Hospice)
Mastercard
Visa
Switch
Delta
Card No: 
Expiry Date: Switch
Issue No:
Gifts from UK tax payers qualify for Gift Aid. By signing the following
declaration, you are allowing the Phyllis Tuckwell Hospice to reclaim the
tax on your donation.
I confirm that I am a UK
taxpayer, and the tax I pay will be at least equal to the tax that the
charity will reclaim on this gift. Please treat all donations I make to the
Phyllis Tuckwell Hospice as Gift Aid donations until further notice.
Signature:……………………………................… Date:……………………………………….
Please note there is no minimum amount we ask you to donate to be involved
in Light Up A Life.
Please
return this form to:
Susan
Crowe, Phyllis Tuckwell Hospice, FREEPOST SCE 4918, Farnham, GU9 8BR
Tel: 01252 729406
Under the terms of the
Data Protection Act, the Phyllis Tuckwell Hospice will retain and use the
data you have provided for administrative purposes and to inform you of its
fundraising and other activities. We hope you will want to remain in touch
with our work, but if you would prefer not to receive future mailings,
please tick this box.
THANK YOU
Registered Charity No: 264501
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A Life
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