Donation form. Make a single or regular gift. Option one: Single donation. Your Details

Transcription

1 Donation form Make a single or regular gift You can use this form to make a single gift to your Tribute Fund or to start a regular donation via Direct Debit. If you are a UK taxpayer please remember to complete the Gift Aid section it will make your donation worth 25% more at no extra cost to you. This form may be photocopied and used by friends and family to make a gift into the Fund. Please return the completed form in the enclosed Freepost envelope. Your Details Please complete in BLOCK CAPITALS. Mr Mrs Ms Miss Other: First name: Last name: Address: Postcode: Daytime telephone: Mobile: I wish to make a donation to the: Tribute Fund Option one: Single donation I wish to make a donation of: Other Please make your cheque or postal order payable to St Elizabeth Hospice. Or please debit the above amount from my: (please tick one box only) MasterCard Visa Maestro Switch Name on card: Card number: Valid from: Expiry date: Issue number (Maestro only): / / Cardholder s signature: Don t forget to fill in the GiftAid section overleaf. Date: To make a regular donation by Direct Debit please fill in the form overleaf.

2 Donation form continued... Option two: Regular donation by Direct Debit I would like to make a regular monthly donation of: Amount of your choice Starting on the: 1st 15th Month (we will write to confirm your first payment date) Year Help your donations go further: Please increase the value of all donations I have made to St Elizabeth Hospice for the past four years and all future donations until I tell you otherwise. I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for each tax year (6 April to 5 April) that is at least equal to the amount of tax that all the charities or St Elizabeth Hospice will reclaim on my gifts for that tax year. I understand that other taxes such as VAT and Council Tax do not qualify. I am unable to Gift Aid Instruction to your bank or building society to pay by Direct Debit. Please fill in the whole form using a ball point pen and send to: St Elizabeth Hospice, 565 Foxhall Road, Ipswich, Suffolk IP3 8LX Name and full postal address of your bank or building society To: The Manager Bank/building society Address Name(s) of account holder(s) Bank/building society account number Branch sort code Postcode Service user number Reference FOR ST ELIZABETH HOSPICE, SUFFOLK OFFICIAL USE ONLY This is not part of the instruction to your bank or building society. Instruction to your bank or building society. Please pay St Elizabeth Hospice, Suffolk, Direct Debits from the account detailed in this Instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this Instruction may remain with St Elizabeth Hospice, Suffolk and, if so, details will be passed electronically to my bank/building society. Signature(s) Date Banks and building societies may not accept Direct Debit Instructions for some types of account. DD17

3 In recognition of the Tribute Fund With the deepest gratitude of everyone at St Elizabeth Hospice Jane Petit Chief Executive Registered Charity

4 Growing your Tribute Fund Seeing a Tribute Fund grow can give you a wonderful sense of achievement and is a powerful and positive way to celebrate and honour the life of someone special. Bill Smith s Tribute Fund 1,000 could fund a Hospice at Home nurse for a week There are so many ways to grow your fund, it can be tailored to suit you and your family and friends. Some people choose to make regular monthly donations or single donations on poignant dates. This can be done using the donation form in this pack. Other ways to grow your fund:. Collect your loose change Having a home collection box for your spare change is a simple but effective way of making a regular contribution to your fund. You could save 100 in no time.. Coffee Morning Get all your family and friends together to share your memories over coffee and cake.. Special Occasions Celebrate your special day and request donations in lieu of gifts or mark an anniversary in memory of your loved one. Donations from Bill s funeral 500 could pay for 24 hours of inpatient care Donations on my birthday 230 could provide Day Care support Coffee morning 120 could pay for a week s meals for an inpatient My loose change collection 90 could provide bereavement support for two children Monthly donations 60 could pay for a music therapy session

5 Sponsored events & challenges Once in a lifetime Overseas Challenges trek, cycle, climb, walk abroad to support local Hospice care at home. Run a marathon test yourself with a running challenge, perhaps start with a 5k run and progress to the big one, the Virgin London Marathon. Join the popular Midnight Walk St Elizabeth Hospice s biggest fundraising event of the year, men and women unite to walk or run in memory of a loved one. Take the plunge with a Skydive an adrenaline buzz you will never forget, but remember to get your friends and family to sponsor you before you jump! Growing your Tribute Fund can be rewarding and fun for everyone involved. We hope we have given you some ideas to get started. Do whatever feels right for you, the possibilities are endless! We are happy to talk with you about any ideas you might have and help you every step of the way.

6 Growing our Tribute Fund Sam V ine s Tribute Fund My wife Sam spent her last day in the Hospice s Inpatient Unit and it made all the difference to her and our family. The Hospice is where she wanted to be at the end of her life. This still brings great comfort to me and our two children Eloise, 11, and Bradley, 9. Even though Sam was cared for on the Inpatient Unit for just one day we felt it was the best day she could get. She was only 38 and we decided to honour her memory with a St Elizabeth Tribute Fund. We received donations to the Hospice at Sam s funeral and within weeks friends and family took part in the Midnight Walk 2013 in her memory, raising over 1,000. Our children wanted to organise a cake sale which also raised over 1,000. Sam s choir at All Hallows Church held a cake sale in aid of the Hospice too. It gives us comfort to have the focus of the Tribute Fund and know the donations are in Sam s name. It has reached over 5,000 and we will add to it as time goes on. The kids want to do another cake sale and we might do a sponsored bike ride. Jason Vine, 39, of Ipswich To read more visit

7 Dominic White s Tribute F und Our beautiful son Dominic had a brain tumour and spent the last few weeks of his life at home in familiar surroundings with us, which was where he wanted to be. This was only possible because of the Hospice at Home team. The night before Dominic died, when we were well aware that he would not be with us for much longer and in our real hour of need, we felt St Elizabeth Hospice sent us an Angel. She was the Hospice at Home nurse who treated Dominic with such love and care and did everything within her power to make Dominic as comfortable as he could be. Within weeks of Dominic s death we became aware of St Elizabeth Tribute Funds and this has been a way of keeping his memory alive and being able to support the work of the Hospice. Friends and family donated directly through the online Tribute Fund web page we had set up rather than at his funeral and this method also gave them the opportunity to leave personal messages and thoughts on his Tribute Fund page. To date we have raised just over 5,000. Dominic s stepfather has run several sponsored races and his employers have matched the funds he raised. I have taken part in the Midnight Walk. Dominic was a very keen on-line gamer and when the gaming company read a newspaper article about him, they donated several hundred pounds worth of games and merchandise which we sold to also raise money for the Hospice. We have plans for future events to continue building the fund. It is nice to know it will always be there and we can add to it as and when, and also, it is comforting to look back at the messages others have left and remember how much everyone cared about Dominic. Alison Roberts, of Woodbridge To read more visit

8 Your Special Memories Many supporters like to share their special memories or stories about the loved one they are remembering with their Tribute Fund. If you would like to tell us about your loved one, we would be honoured to hear more. Simply send your memories to us in the enclosed Freepost envelope. We guarantee that this information will be held confidentially, and will not be used without your prior permission. Tribute Fund name: Your name: Your relationship to the person being remembered: Your special memories: (continue overleaf)

9 Your Special Memories Your special memories (continued): n Please tick here if you would like us to add your special memories to your online page on your behalf. n Please tick here if you would be happy for your special memories to be used for publicity purposes. We will contact you to explain how.