Daisy chain form

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Details of Daisy Chain Dedication

Important - Please enter the name of the person the dedication is BY and TO
Dedicated BY (your name)*
Email*
Enter Email Confirm Email
Dedicated TO*
Your Dedication
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A daisy in our online daisy garden*
If you wish your dedication to appear as a daisy in our online daisy garden please select below. Please note - it is not compulsory to upload a photograph.
- Yes, please show my daisy online
- No, please don't
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First name of person in dedication*
First name of person in dedication*
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Last name of person in dedication*
Last name of person in dedication*
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Type their name as you would like it to appear on the dedication*
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Type their name as you would like it to appear on the dedication*
Would you like a plaque in the Hospice Memory Garden?*
- Yes
- No
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Memory Category
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Your dedication message (online garden)
limited to 150 characters including spaces
Your plaque message (Hospice Memory Garden)
If you opt to have a plaque in our Memory Garden, this message will be displayed on your plaque, alongside the name of your loved one
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Your dedication message
limited to 150 characters
If you live outside of the UK and wish to dedicate a daisy please contact: fundraising@wlh.org.uk to arrange payment.
Communications*
- I would like to receive information from Wigan & Leigh Hospice on the latest updates, events, e-newsletter and other information that may be of interest to me.
- No thanks
Consent
I agree to the privacy policy.