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I would like to donate:

Yes, I would like to Giftaid my donations

Thank you

Choosing to Gift Aid your donation means we will now receive an additional £1.25 from HM Revenue and Customs at no extra cost to you.

St Columba’s Hospice can treat the enclosed donation and any future donations I give as a Gift Aid donation. I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year it is my responsibility to pay any difference.

Single Donations are via Credit or Debit Card.

Please tell us

Would you like*:The Hospice team to fill in the dedication on your behalf?

In memory of*:+

My special message is:

Please tell us where you would like your dedication posted to:

Anything else you’d like us to know about your donation:300300

Please tick here if you would like to receive separate card for each person you are making a dedication forPlease tick here if you don’t want to receive any cards

How did you hear about this appeal?*:

Address*:

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Personal details

Title*:

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Telephone number*:

Address*:

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Contacting you

Occasionally we would like to keep you up to date with details of our work, fundraising events and ways to get involved. Your information will not be passed on to third parties. However if you would rather not hear from St Columba’s Hospice in the future please tick this box.