Material Memories order form - St Elizabeth Hospice

Please complete the below form to start your Material Memories order.

First Name*
Last Name*
Email*
Enter Email* Confirm Email*
Address*
Street Address* Address Line 2 City* County* Postcode* Country
Please provide any specific requirements e.g badges, specific part of material*
Contact preferences
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.
- Please send me mail
- Phone calls are ok
- Please send me email
- Please send SMS (text)
Gift Aid it

Boost your donation by 25p of Gift Aid for every £1 you donate.
Gift Aid
- I declare that I am a UK tax payer and would like all donations to St Elizabeth Hospice in the last six tax periods and all future donations to be Gift Aided until further notice.
If I have ticked the box headed ‘Gift Aid’, 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.
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