Saint Michael's one off donation

Salutation *

First Name *

Last Name *

Street Address *

Address Line 2

City *

Post Code *

Email Address *

Telephone number (in case we need to contact you about your donation) *

Date of birth * +

Your donation

Amount you wish to donate *

Reason for your donation? *

Your information will be used by Saint Michael’s Hospice, to provide you with the best service possible. Your details are safe with us. We will not sell or swap them. We will only use them in accordance with our information notice

Regular Giving

If you wish to make this a regular donation please tick this box. A member of our team will contact you to take further details.

Boost your donation by 25p of Gift Aid for every £1 you donate.
In order to Gift Aid your donation, you must tick the box below.
I am a UK taxpayer and understand that if I pay less Income/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.
Please notify the charity if you:
- Want to cancel this declaration
- Change your name or home address
- No longer pay sufficient tax on your income/capital gains tax
If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self-Assessment tax return or ask HM Revenue and Customs to adjust your tax code. *

I want to Gift Aid this donation and any donations I make in the future or have made in the past four years to Saint Michael's Hospice.

I am not a UK taxpayer

Staying in touch

Thank you so much for your donation - your support will make a huge difference to people living with terminal illness. We would like to keep you up-to-date about our work, fundraising activities and ways to get involved.

Email and SMS are quick and cost effective. Please let us know if you are happy for us to stay in touch in these ways.

Email

Yes please, I’d like to hear from you by email

No thank you, I don’t wish to hear from you by email

Text message

Yes please, I’d like to hear from you by text message or MMS

No thank you, I don’t wish to hear from you by text message or MMS

Mail and telephone are also important ways we can communicate with you. Please tell us if you would rather we didn’t contact you in these ways.

No thanks, please don’t contact me by post

No thanks, please don’t contact me by telephone

You can update your preferences or unsubscribe from marketing at any time by calling us on (01423) 878 628 or emailing supportercare@saintmichaelshospice.org

By submitting this form you confirm that the above details are correct, and you have read and accept the information notice.

Saint Michael's uses third party form provider, Formsite. When you submit your information, you'll receive an email notification from Saint Michael's via Formsite.

North Yorkshire Hospice Care is a registered charity in England and Wales (518905) with a family of services operating as Herriot Hospice Homecare, Just ‘B’, Saint Michael’s Hospice and Talking Spaces.

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