Title: Forename: Surname:

Address:

Post code: Tel:

Donation informationI enclose a total of £ Cash/Cheque/Credit or Debit Card (please delete)

Completed forms and donations should be returned to: Kirkwood Hospice, 21 Albany Road, Huddersfield, HD5 9UY. Please do not post cash. Cheques should be made payable to Kirkwood Hospice.

Cardholder name:

Card number:

Valid from: Expiry date: Security no

Boost your donation by 25p of Gift Aid for every £1 you donate!Gift Aid is reclaimed by the charity from the tax you pay for the current tax year. Your address is needed to identify you as a current UK taxpayer.

In order to Gift Aid your donation you must tick the box below:

I am a UK taxpayer and 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. Please notify the charity if you:

· want to cancel this declaration

· change your name or home address

· no longer pay sufficient tax on your income and/or capital gains

If you pay Income Tax at the higher or additional rate and want to receive the additional tax relief due to you, you must include all your Gift Aid donations on your Self-Assessment tax return or ask HM Revenue and Customs to adjust your tax code.

Signed: Date:

Your communication preferencesWe will use your address details to send you news about Kirkwood Hospice, how your support helps patients and families and other ways in which you could help, unless you tell us not to by contacting our Fundraising Team on: 01484 557911 or by emailing: fundraising@kirkwoodhospice.co.uk

Tree of Memories‘Memories are timeless treasures.

We should hold on to them and keep them close to our hearts.’

Registered Charity No. 512987

Dedicate a leaf or sunflower in celebration of someone you love

I want to Gift Aid my donation and any donations I make in the future or have made in the past 4 years to Kirkwood Hospice

Your details

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Alternatively, orders can be made online by visiting: www.kirkwoodhospice.co.uk/treeofmemories

Kirkwood’s Tree of Memories is a beautiful way to honour someone you love.

The tree incorporates 420 beech leaves of gold, silver and bronze that can be engraved with a name or a short personal message in return for a donation. A number of attractive sunflowers can also be engraved. The tree is located inside the Hospice, next to our main reception.

Important informationLeaves and sunflowers are offered in exchange for direct donations. Unfortunately, we cannot accept contributions from funeral collections.

Please allow a minimum of 4 weeks for your leaf or flower to be engraved. Prior to engraving, you will receive a certificate confirming the wording of your inscription.

Inscriptions should be a celebration of your special person, and will be displayed alongside others for everyone to see. For this reason, we respectfully request that dates of death are avoided.

Donation form Please complete both sides of this form to order your leaf or sunflower.

Inscriptions on a leaf or sunflower can consist of 15 characters per line, including spaces, up to a maximum of 4 lines

Leaves and sunflowers will remain on the tree for a set period of time. For leaves, this will depend on the colour you choose. After this period, you will be invited to renew your donation and keep your leaf or sunflower on the tree. Or we can send it to you for you to keep and cherish forever.

Our Tree of Memories provides us with an opportunity to remember the people we love in a tangible way. Donations generated from the tree will help fund our work in the years to come.

To find out more about the Tree of Memories, please call us on: 01484 557911 or email: fundraising@kirkwoodhospice.co.uk

Your orderPlease select your chosen leaf colour or sunflower:

Your inscription Please engrave the following name or message on my leaf or sunflower:

You will be contacted two months prior to the end of your chosen period with an option of a further period of display in return for a renewal donation.

We have carefully chosen the location of our tree to provide a balance between visibility and privacy. As a result, there will be times when the tree is not accessible for viewing. We recommend that you please contact us ahead of your visit to guarantee access.

£100 donation.

Leaf to remain on

the tree for one year

£200 donation.

Leaf to remain on

the tree for two years

£300 donation.

Leaf to remain on

the tree for three years

£1500 donation.

Sunflower to remain on

the tree for three years

Bronze Silver

Gold Sunflower

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