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Fill in the form below to donate your anniversary years to the hospice!
Name
(Required)
First
Last
Postal address:
(Required)
Street Address
Address Line 2
City
County
Avon
Bedfordshire
Berkshire
Buckinghamshire
Cambridgeshire
Cheshire
Cleveland
Cornwall
Cumbria
Derbyshire
Devon
Dorset
Durham
East Sussex
Essex
Gloucestershire
Hampshire
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Isle of Wight
Kent
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London
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Norfolk
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Warwickshire
West Midlands
West Sussex
West Yorkshire
Wiltshire
Worcestershire
Clwyd
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Gwent
Gwynedd
Mid Glamorgan
Powys
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West Glamorgan
Aberdeenshire
Angus
Argyll
Ayrshire
Banffshire
Berwickshire
Bute
Caithness
Clackmannanshire
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Dunbartonshire
East Lothian
Fife
Inverness-shire
Kincardineshire
Kinross-shire
Kirkcudbrightshire
Lanarkshire
Midlothian
Moray
Nairnshire
Orkney
Peeblesshire
Perthshire
Renfrewshire
Ross-shire
Roxburghshire
Selkirkshire
Shetland
Stirlingshire
Sutherland
West Lothian
Wigtownshire
Antrim
Armagh
Down
Fermanagh
Londonderry
Tyrone
Postcode
Telephone number:
Email address:
(Required)
Enter Email
Confirm Email
Date of Birth:
(Required)
MM slash DD slash YYYY
What anniversary are you celebrating?
(Required)
Tell us if you have a connection to the hospice:
(Required)
You may have received care yourself, had a family member or friend receive care, volunteer or attended one of our events previously.
Enter your donation amount:
(Required)
Donate your anniversary years or round it up!
Total
£ 0.00
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We would like to stay in touch with you to let you know how your support makes a difference, and other ways you can get involved. We will hold your personal information in accordance with the Data Protection Act 1998 and we will not pass on your personal information to third parties. View our privacy policy at: https://www.stelizabethhospice.org.uk/privacy-policy/
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