Order your Daisy Dedication

Dedicate a keepsake daisy in memory of your loved one via the form on this page.

Please note, if you order more than one daisy, you will need to collect in person.

Once arrived, you will need to print out your own photo and message to insert into the daisy. Find out how to do this on the FAQ page or Daisy Dedication homepage.

Remember a loved one by making a Daisy Dedication with
St Elizabeth Hospice

"*" indicates required fields

Your name*

Prefix First Last

Address*

Street Address Address Line 2 City County Postcode

Email*

Phone*

Daisy Dedication Suggested Donation:

Price:

If you would like to make an alternative donation to £35, please call our fundraising team on 01473 723600.

How many Daisy Dedications would you like to order?*

Who are you remembering?

First Last

1st Daisy Dedication:

If you are remembering more than one person, please list all the names of those you'd like to dedicate to.

First Last

2nd Daisy Dedication:

First Last

Third Daisy Dedication:

First Last

Fourth Daisy Dedication:

First Last

Fifth Daisy Dedication:

First Last

How would you like to collect your Daisy Dedication?*

If you have selected to collect your daisy from the hospice, a member of our team will call to arrange a time and date for collection with you. If you select to have the daisy posted, please note that charges apply.

If you would like to add an extra donation on top of your daisy, please enter the amount you would like to donate to the hospice:

Boost your donation by 25p of Gift Aid for every £1 you donate.

Tick below as appropriate to make your declaration.

If I have ticked the box, I confirm that I am a UK Income or Capital Gains taxpayer. I have read this statement and want St Elizabeth Hospice to reclaim tax on the donation given. I understand that if I pay less Income Tax / or Capital Gains tax in the current year than the amount of Gift Aid claimed on all of my donations it is my responsibility to pay any difference. I understand St Elizabeth Hospice will reclaim 25p of tax on every £1 that I have given.

I am unable to give Gift Aid

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Order your Daisy Dedication

Remember a loved one by making a Daisy Dedication with St Elizabeth Hospice

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Remember a loved one by making a Daisy Dedication with
St Elizabeth Hospice