St Wilfrid's Hospice - 40th Anniversary Brochure

Your gift will help a patient in the future
1. I would like to make a single gift of:
£40 to provide a home visit for a patient
£400 to sponsor care for a patient for a day. My special day is D D / M M date/month (optional)
£4,000 to fund a patient over a ten day period
My own amount of: £ I am donating in memory of their name (optional)
I enclose a cheque made payable to St Wilfrid’s Hospice (Eastbourne)
Please debit my card:
Card number:
Expiry date M M / Y Y
Type of card: Credit card OR Debit card Name on card:
Signature:
Date: D D / M M / Y Y
2. I would like to make a regular gift and become a Friend for Life
Please pay the sum of £ to the account of St Wilfrid’s Hospice (Eastbourne), Barclays Band plc, Eastbourne.
Sort code: 20-27-91 Account no 90450839. On the D D (day) of M M (month) Y Y Y Y (year) and
on the same day of each subsequent month until further notice (please allow one month’s leeway). This standing
order mandate is in addition to any other mandates you have for St Wilfrid’s (Eastbourne).
Bank name: Account name:
Sort code: – – Account number:
Signature:
Date: D D / M M / Y Y
3. Your details (your full first name, surname and address are needed to identify you as a UK taxpayer)
Title: First names(s): Surname:
Address:
Postcode: Phone: Email:
4. Gift Aid – add 25% to your donation at no additional cost to you
Please tick if the following statement applies to you.
I am a UK taxpayer and would like St Wilfrid’s Hospice (Eastbourne) to treat any donation that I have
made for the four years prior to the year of this declaration, and all donations I make from the date
of this declaration until I notify St Wilfrid’s Hospice (Eastbourne) otherwise, as Gift Aid declarations.
5. Can we keep in touch?
We would like to thank you and keep you informed about our news and events. We feel there is a legitimate
interest in keeping you up to date with the work that we are doing and letting you know how you can get
involved. This would normally be by email.
Tick here if you wish to stop all contact from St Wilfrid’s Hospice (Eastbourne)
(Please note you will be removed from all mailings and we will never contact you again if you tick this box)
Tick here to consent to be contacted by email, please provide us with your email address above. (We will never
sell or share your data with a third party. For details about how we use your data visit stwhospice.org/yourdata)
St Wilfrid’s Hospice, 1 Broadwater Way, Eastbourne, East Sussex BN22 9PZ Registered Charity No: 283686