Light Up A Life

To dedicate a light, in memory of a loved one, please complete the below form.

Thank you for your support.

Your Details

Title: (*)

Forename: (*)

Surname: (*)

Postcode (first section): (*)

Postcode (second section): (*)

Choose Your Address:

Address Line 1: (*)

Address Line 2:

Town: (*)

Telephone:

Email: (*)

Please retype your email address

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Gender:

Date Of Birth (dd/mm/yyyy)

Date Of Birth:

Where did you hear about Light up a Life:

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I would like to dedicate a light in memory of (please state the full name of each person)

Person 1 First Name: (*)

Person 1 Surname: (*)

Person 2 First Name:

Person 2 Surname:

Person 3 First Name:

Person 3 Surname:

Person 4 First Name:

Person 4 Surname:

In memory of a loved one/s I would like to donate (£)

Donation: (*)

Gift Aid Declaration

I would like St Oswalds Hospice to treat all donations that I have made in the past 4 years and all future donations from the date of this declaration as Gift Aid donations. St Oswalds Hospice will reclaim 25p of tax for every £1 you give. You must pay an amount of Income and/or Capital Gains Tax that is at least equal to the amount St Oswalds Hospice reclaims on your gift(s). Please contact St Oswalds if you want to cancel this declaration, change your name or move house, or no longer pay sufficient Income and/or Capital Gains Tax.
Gift Aid