Join our Lottery
Complete your details below or join online at www. stgileshospice. com / lottery
1 Your details
Title: First name:
Surname:
Address:
Telephone:
Mobile:
Email:
Postcode:
Your support matters. Thank you.
“ One of the things I realised as a carer was that St Giles doesn’ t fund itself. The wonderful advice, guidance, help and support that we had comes from the generosity of others.”
Craig Johnson, Sutton Coldfield
No matter how big or small, donations to support St Giles Hospice are always welcome.
If you would like to make a donation, you can do so in these ways
1 Online at www. stgileshospice. com / donate
2 By calling 01543 432538
3 Using this form I would like to make a donation of £............. to St Giles Hospice.
2 Payment amount and frequency
Title: First name:
For ONE entry per week( please tick box) Monthly @ £ 4.34 Every 26 weeks @ £ 26 Every 13 weeks @ £ 13 Every 52 weeks @ £ 52 Monthly @ £ 5(£ 4.34 lottery & 66p donation)
3 Choose a payment method
Surname:
Address:
Telephone:
Postcode: a) Standing order
Please complete this section with details of your own account and return to St Giles Lottery Office – not your bank.
To( your Bank name)
Pay Lloyds Bank, Lichfield, Sort Code 30-95-04 for the credit of St Giles Hospice( Promotions) Ltd. Account No. 01049604
Your account name: Your account number: Sort Code: First payment to commence immediately.
Bank Quoting Reference( for office use only):
b) Cheque( minimum £ 13) payable to St Giles Hospice
If you prefer to pay by card go online at www. stgileshospice. com / lottery or call 015243 434020.
4 Data Protection
By completing this form you are giving consent for St Giles Hospice Lottery to use your data for administrative purposes related to your lottery play. We value the support we receive from our local community and take the protection of your data very seriously. We will never pass your information to anyone outside of the St Giles Hospice Group who isn’ t directly working on our behalf, and we will keep your details safe and secure.
We would occasionally like to send you information about St Giles Hospice’ s work, events and activities – please tell us how you would like to hear about these in the orange communication preferences overleaf.
5 Sign and date By signing you are confirming you are over 16 Signature: Date:
Return your form( and payment if applicable) in the envelope enclosed or to the address below. Once we receive your completed form we will process your lottery application and you should receive your lottery welcome pack within 10 days.
St Giles Hospice, Fisherwick Road, Whittington, Lichfield, WS14 9LH Tel: 01543 434020 | Email: lott @ stgileshospice. com
St Giles Hospice( Promotions) Limited( UK 3238435), T / A St Giles Hospice Lottery, registered office as above, is a wholly-owned subsidiary of St Giles Hospice( Registered Charity No: 509014). Responsible Persons: Alison Jerram and John Malcolm Godfrey. Licensed by the Gambling Commission www. gamblingcommission. gov. uk and a member of the Hospice Lotteries Association and The Lotteries Council. St Giles Hospice promotes responsible gambling. For practical help and support on problem gambling please contact GamCare on 0808 8020 133 or visit www. begambleaware. org if needed. For further details and full terms and conditions visit www. stgileshospice. com / lottery
Mobile:
Email:
I enclose a cheque / P. O./ CAF * voucher made payable to St Giles Hospice *( Please delete as appropriate)
Signature
Date
Please send your cheque along with this completed form in the envelope enclosed or to this address:
St Giles Hospice, Fisherwick Road, Whittington, Lichfield, WS14 9LH
If you do not require acknowledgement or receipt for your donation, please tick here
If you would like to receive information about making a donation in your will, please tick here
For every £ 1 you give we get an extra 25p from HMRC. To enable St Giles Hospice to reclaim the tax on your donation simply tick the box below.
By ticking this box, I confirm that I am a UK taxpayer. I have read this statement and want St Giles Hospice to reclaim tax on all my donations, past, present and future. I understand that if I pay less Income Tax and / or Capital Gains Tax in the current tax year than the amount of Gift Aid claimed on all of my donations, it is my responsibility to pay any difference.
Data Protection: By completing this form you are giving consent for St Giles Hospice to use your data for administrative purposes related to this donation. We value the support we receive from our local community and take the protection of your data very seriously. We will never pass your information to anyone outside the St Giles Hospice Group who isn’ t directly working on our behalf, and we will keep your details safe and secure.
Communication Preferences: St Giles Hospice Group will also use your personal data to send you occasional information by post about our work, events and activities, on the basis of our legitimate interest to do so, in order to help us continue to care for local people and their families. If you would prefer not to hear from us in this way, please tick
We are also trying to reduce costs by sending this information electronically where appropriate. Please let us know if you are happy to receive information about our work, events and activities in the following ways by ticking the relevant boxes:
Email Text Telephone
Remember, you can change your choices at any time by just contacting us to let us know. Our full Privacy Statement is available at www. stgileshospice. com / privacy-statement or by calling 01543 432538.