Dedication Form - Wigan & Leigh Hospice

Details of Daisy Dedications

Important - Please enter the name of the person the dedication is BY and TO

Dedicated BY (your name)*

Dedicated TO*

Your details

Title*

First name*

Last name*

Address*

Address 1 * Address 2 Town * County * Postcode*

Telephone*

Email address*

Enter email* Confirm email*

Your Dedication

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. Your daisy will stay in the online garden for 12 months.

Yes, please show my daisy online
No, please don't

First name of person in dedication*

Last name of person in dedication*

Type their name as you would like it to appear on the dedication*

Hidden

Memory Category

Your dedication message*

limited to 150 characters including spaces (your message may be summarised on classic daisies but will appear as written on our website)

Your dedication message

limited to 150 characters including spaces (your message may be summarised on classic daisies but will appear as written on our website)

Picture

maximum file size: 50MB
file types accepted: jpg, jpeg, png, gif

Image size: 182 x 182 pixels

Accepted file types: jpg, jpeg, png, gif.Select Photo

If you live outside of the UK and wish to dedicate a daisy please contact: fundraising@wlh.org.uk to arrange payment.

Your Donation

As well as having a daisy dedicated to your loved one in our online daisy garden you may wish to have one of our specially designed hospice daisies. For a minimum donation of £10 you will receive a classic daisy. For a minimum donation of £25 you will receive a metal daisy. All metal daisies are posted out. Your daisy can be posted to you or, if you choose a classic daisy, you can have a daisy featuring the name of your loved one planted in our memorial garden at the hospice. If you choose to have a daisy in our remembrance garden you will be contacted after 12 months to arrange collection.

Choose your Daisy

Let us know how many of each daisy you would like. If you choose Classic Daisy you have a choice. If you choose Metal Daisy your daisy will be posted.

A. Classic Daisy

Classic daisy

Price: £ 10.00

My choice

B. Metal Daisy

Metal daisy

Your metal daisy will be posted to you.

Price: £ 25.00

C. Other donation

If you would like to make a larger donation - or do not want a classic/metal daisy - please put your donation amount in the box below

Donation

Total

£ 0.00

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 tax payer

Gift Aid

Gift Aid is a government scheme for UK charities to reclaim the tax you have paid and gain 25% more at no cost or hassle to you. I am a UK tax payer and I understand that if the Gift Aid claimed on my donation/s is more than the tax I pay in the current tax year (on my income and/or capital gains), it’s my responsibility to pay the difference.

I wish Wigan & Leigh Hospice to claim Gift Aid on 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.
I want to Gift Aid this donation only
No, do not add Gift Aid

We would like to keep you up to date with the work we do here at the Hospice.

Please subscribe me to the Hospice E-Newsletter

We will not share your information with other organisations.

We would like to keep you up to date with the work we do here at the Hospice.

Please subscribe me to the Hospice newsletter In Touch which is sent twice a year.

We will not share your information with other organisations.

Please notify us on 01942 525566 if you:

Want to cancel this declaration or Change your Name and/or Home Address
No longer pay sufficient tax on your income and/or capital gains.