Christmas Appeal "*" indicates required fields 1Amount2Your details3Billing details4Gift aid Thank you so much for supporting our Christmas Appeal. Suggested Donation Amount £30 – Could help provide medical or personal items such as pressure-relieving cushions. £100 – Could pay for six counselling sessions to support a patient. £300 – Could pay for a series of counselling and holistic therapy sessions. £500 – Could pay for a Community Nurse for two days to help patients in their own homes. £1,000 – Could pay for the catering team for two days. £1,008 – Could provide seven days of care from Healthcare Assistants at home or in the hospice. £7,000 – Could pay for five community nurses for a week. Enter Amount* Title*MrMrsMissDrMsProfRevLadySirFirst name*Last name*PhoneEmail Further detailsAre you giving in memory of a loved one Are you giving in memory of a loved one? Loved ones nameReason for donation Address line 1*Address line 2Town/City*County/StatePostcode*Country*AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Gift AidPlease treat any donations I make in the future and have made in the past four years prior to the date of this declaration as Gift Aid donations unless I notify you otherwise. By ticking the box, I can confirm that I am a UK Income or Capital Gains Taxpayer and understand that if I pay less Income and/or Capital Gain 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 understand the charity will reclaim 25p of tax on every £1 that I have given. Yes, add Gift Aid Thank you for your gift to protect hospice care for generations to come. To complete your donation please click ‘Donate via Sage Pay’ to enter your payment details.