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Step 1 of 5 - Your Information

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Your Information

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Your Name*

Title First Name Last Name

Email Address*

Your Address*

Street Address Address Line 2 Town County Postcode

Telephone No.

Light up a Life dedications

Please tell us below who you would like to dedicate a light to.

Would you like to make any Light up a Life dedications?

Yes

How many dedications would you like to make?

Light 1

A light is shining for

Please tell us the name of the person you would like to dedicate a light to.

First Name Middle Name Last Name

Would you like to receive a Light up a Life card for Light 1?*

Please let us know if you would like to receive a Light up a Life card

Name of the person remembered for your card

Please tell us how you would like the name of the person remembered to appear in your Light up a Life card

Message

Please let us know here if you would like a short message to appear in your Light up a Life card. Please do not use emoji's as this may cause an error.

From

Please let us know here who this Light up a Life card is from. Please do not use emoji's as this may cause an error.

Light 2

A light is shining for

Please tell us the name of the person you would like to dedicate a light to.

First Name Middle Name Last Name

Would you like to receive a Light up a Life card for light 2?*

Please let us know if you would like to receive a Light up a Life card

Name of the person remembered for your card

Please tell us how you would like the name of the person remembered to appear in your Light up a Life card

Message

Please let us know here if you would like a short message to appear in your Light up a Life card. Please do not use emoji's as this may cause an error.

From

Please let us know here who this Light up a Life card is from. Please do not use emoji's as this may cause an error.

Light 3

A light is shining for

Please tell us the name of the person you would like to dedicate a light to.

First Name Middle Name Last Name

Would you like to receive a Light up a Life card for Light 3?*

Please let us know if you would like to receive a Light up a Life card

Name of the person remembered for your card

Please tell us how you would like the name of the person remembered to appear in your Light up a Life card

Message

Please let us know here if you would like a short message to appear in your Light up a Life card. Please do not use emoji's as this may cause an error.

From

Please let us know here who this Light up a Life card is from. Please do not use emoji's as this may cause an error.

Would you like to sponsor a fourth light?

Yes

Light 4

A light is shining for

Please tell us the name of the person you would like to dedicate a light to.

First Name Middle Name Last Name

Would you like to receive a Light up a Life card for light 4?*

Please let us know if you would like to receive a Light up a Life card

Name of the person remembered for your card

Please tell us how you would like the name of the person remembered to appear in your Light up a Life card

Message

Please let us know here if you would like a short message to appear in your Light up a Life card. Please do not use emoji's as this may cause an error.

From

Please let us know here who this Light up a Life card is from. Please do not use emoji's as this may cause an error.

Light 5

A light is shining for

Please tell us the name of the person you would like to dedicate a light to.

First Name Middle Name Last Name

Would you like to receive a Light up a Life card for Light 5?*

Please let us know if you would like to receive a Light up a Life card

Name of the person remembered for your card

Please tell us how you would like the name of the person remembered to appear in your Light up a Life card

Message

Please let us know here if you would like a short message to appear in your Light up a Life card. Please do not use emoji's as this may cause an error.

From

Please let us know here who this Light up a Life card is from. Please do not use emoji's as this may cause an error.

Light up a Life Donation

How much would you like to donate?

We kindly ask a minimum donation of £5.00 per dedication

Light up a Life Keepsakes

Wooden Tree Hanger

Please tell us if you would like to order a wooden tree hanger. We kindly ask for an additional donation of £5.00 per tree hanger

I would like to order a tree hanger

I do not wish to order a tree hanger

How many wooden tree hangers would you like to order?*

How much would you like to donate for your wooden tree hangers?

We kindly ask a minimum donation of £5.00 per tree hanger

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Light up a Life Book of Honour

Please tell us if you would like to order a Light up a Life Book of Honour. We kindly ask an additional donation of £5.00 per Book of Honour

I would like to order a Light up a Life Book of Honour

I do not wish to receive a Light up a Life Book of honour

This field is hidden when viewing the form

How many Books of Honour would you like to order?

How much would you like to donate for your Book of Honour

We kindly ask a minimum donation of £5.00 per Book of Honour

How did you hear about Light up a Life?

Tell us how you heard about this year's Light up a Life

Other

Please tell us where you heard about Light up a Life

Communications by Wirral Hospice St John's

Wirral Hospice St John’s would like to use the information you have provided to contact you with news and information about the work, fundraising activities, events, goods and services of Wirral Hospice St John’s and its group companies. However, we may occasionally use carefully selected agents to process this information on our behalf. We will not pass on your details to any other organisation. Please see our Privacy Statement for more information.

Mail by post

Please tell us which mailings you WOULD NOT like to receive by post

Christmas Catalogues

Events Mailings

Fundraising Asks

Legacy Mailings

Light up a Life Mailings

Lottery Mailings

Memorial Campaigns

Newsletters

Regular Giving Mailings

Volunteer information

Email Communications

We send e-newsletters using the email system Mailchimp. We send these out about fortnightly. Please tell us if you would like to receive e-newsletters. You can unsubscribe from e-newsletters at any time using the 'unsubscribe' button at the bottom of all e-newsletters

Yes please send me e-newsletters

Telephone Communications

We do not currently engage in telemarketing activity or plan to in the future. We usually only call people in relation to confirming details about an address or if a donation/payment has not processed for some reason. If you do not want us to call you for any reason please let us know below.

Please do not call me for any reason

Donation Summary

Light up a Life Donation

Tree Hanger Donation

Book of Honour Donation

Total Donation

Is your donation eligible for Gift Aid?

Using Gift Aid means that we get an extra 25% from the Inland Revenue, helping your donation go further.

I want Wirral Hospice St John’s to treat my donation and all donations I have made in the last four years and all donations I make from the date of this declaration until I notify you otherwise as Gift Aid donations. I understand that if I pay less income tax and/or 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.

I am not a UK Taxpayer and cannot Gift Aid this donation

1. To qualify for Gift Aid you must have paid enough UK Income Tax and/or Capital Gains Tax at least equal to the amount that all charities and Community Amateur Sports Clubs will reclaim against my gifts to them in the appropriate tax year, currently 25p for each £1 that you donate. Other taxes such as Council Tax and VAT do not qualify.

2. You can cancel this declaration at any time by notifying Wirral Hospice St John’s.

3. If in the future your circumstances change and you no longer pay tax on your UK Income and Capital Gains equal to the tax claimed by Charities, you can cancel your declaration.

4. If you pay tax at the higher rate you can claim further tax relief in your Self-Assessment tax return.

5. If you are unsure whether your donations qualify for Gift Aid tax relief, please contact us or refer to the HMRC website

6. Please notify us if you change your name or address.

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Your Information

Light up a Life dedications

Light 1

Light 2

Light 3

Light 4

Light 5

Light up a Life Donation

Light up a Life Keepsakes

How did you hear about Light up a Life?

Communications by Wirral Hospice St John's

Donation Summary

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Consistently Outstanding: Hospice at Home and Patient...

Alison’s Arctic Adventure: Hospice OT to swim in the...