Dedication Form - Wigan & Leigh Hospice

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

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

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*

Would you like to add a picture to your dedication?*

Yes
No

Hidden

Memory Category

Your dedication message (online garden)

limited to 150 characters including spaces

Your dedication message (hospice remembrance garden)

If your regular gift is £5 per month or more we will plant a personalised daisy in the hospice gardens. Message limited to 20 characters

Your dedication message

limited to 150 characters

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.

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.

Name

This field is for validation purposes and should be left unchanged.