In-Memory Donation - St Gemma's Hospice

To ensure we are able to process your donation securely we would like some initial information to assist us in validating some of the identification data you will need to provide in kindly making this in memory donation to us. Thank you for your support.

Full name *

Email Address *

Enter email

Confirm Email Address *

Please confirm email address

Phone number *

My donation is in memory of:

This person was my:

Was this person a St Gemma's patient?

Yes

No

How did we care for that patient?

as an inpatient

through community nursing

in the Day Hospice

If this donation is from any fundraising activity, event or sponsored challenge, please give details below:

Are you a UK taxpayer?

Add 25% to the value of your donation: Gift Aid is reclaimed by St Gemma's Hospice from the tax you pay for the current tax year. This means we can increase the value of your donation by 25p for every £1 you give. All you need to do is tick the box below and we will do the rest. If this is a gift on behalf of a number of people, unfortunately you will not be able to gift aid it.

Do you want to Gift Aid this donation? *

Yes

No

Gift Aid Declaration

Yes, I would like St Gemma's Hospice to claim back the tax on any donations I have made in the last 4 years and all future donations, until I give further notice. I confirm 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 year it is my responsibility to pay any difference. Please notify us if you want to cancel this declaration, change your home address or no longer pay sufficient tax.

How we communicate with you

As a valued supporter we really want to keep you posted about news and events across St Gemma’s and to share how your support benefits local patients and their families. We will contact you for administrative purposes regarding this interaction. We will usually send you information by post; if you would also like to receive email updates please let us know. If you wish to change how we send you information or choose not to hear from us at all, there are a variety of ways you can do this. Ring us on 0113 218 5555, email supportercare@st-gemma.co.uk or update your preferences online at www.st-gemma.co.uk/mydata. For further information on how we use and store your details please visit www.st-gemma.co.uk/privacy. We will never sell your personal information.

I am happy to be contacted by email in the future: *

Yes

No

Vaidation Code Required *