Event Booking

Step 1 - Supporter Details

Title*

First Name*

Surname*

Telephone Number*

Email Address*

Postcode*

House Number and Street*

Address Line 2

Town / City*

County*

Step 2 - Please enter further information

My first light is in memory of

My second light is in memory of

My third light is in memory of

My fourth light is in memory of

Donation Amount (£)*

I would like each dedication on a separate card:*

I would like to donate without a dedication:

Name of Cardholder:*

I would like to celebrate at home, and receive a tealight in my dedication pack

Step 3 - 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

Gift Aid

*I would like St Gemma’s Hospice to treat all donations I have made in the last four years and until I give further notice as Gift Aid donations. I confirm that 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. I understand that other taxes such as VAT and Council Tax do not qualify. I understand that St Gemma’s Hospice will reclaim 25p of tax on every £1 that I donate.

Claim Gift aid on my donation

Declaration

I understand by making a donation that I am welcome to attend either the in-person or online event and I will receive information about accessing both types of event.
I understand that, in light of the current situation with COVID-19, the format of this event is subject to change depending on government guidance, which we are monitoring closely.
I understand that by making a donation, St Gemma's Hospice will contact me about Light Up A Life.
I understand that a photographer may be attending the event. All photographs are the property of St Gemma's Hospice. I consent that any photographs taken at the event which include me may be used for future Hospice marketing and publications.

I agree to the declaration