Dedicate a leaf on the Tree of Life

Tree of Life

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Name(Required)

Title First Last

Email address(Required)

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Address(Required)

Address Line 1 Address Line 2 City County Postcode Country

Phone number

I would like to dedicate a leaf in memory of:(Required)

Who died on(Required)

This person was my:(Required)

Did your loved one receive care from St Gemma's Hospice?

Yes

Donation Amount(Required)

£25

£50

£100

Other amount

Other Single Amount

With Gift Aid, your donation of £0 would be worth £0.00 at no extra cost to you.

I want to add Gift Aid

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:(Required)

Yes

You are donating

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Add your dedication

Tree of Life

How we communicate with you