ST. RICHARD’S HOSPICE
SPONSOR FORM
Worcester
WINEathlon
On Sunday 13th September
________________ is taking part in this event to
help raise money to support patients & families
How YOUR donation can help …
 £5 will pay for a delicious and nutritious lunch for our patients
 £12 will give a patient an hour of care and emotional support at home
 £20 will provide an hour’s care in our In-patient Unit
NAME:
ADDRESS:
POSTCODE:
TELEPHONE:
EMAIL:
COMPANY:
Fundraising Department, St. Richard’s Hospice, Wildwood Drive, Worcester, WR5 2QT
Tel 01905 763963
www.strichards.org.uk
You can now raise funds online – Just go to www.justgiving.com
and follow the instructions to create your own
fundraising page.
Name of Page _______________________
(Please note if you wish your online funds to be allocated to a forget-menot fund then please insert the name of the forget me not fund in the page
title, without this it cannot be processed)
Help us to make your money go further – simply fill out the form below and let us do the rest!
ST RICHARD’S HOSPICE - Tax Declaration Please fill out the form, if appropriate
YES, I am a UK tax payer and would like St Richard’s Hospice to reclaim the tax on any of the donations I have made in the last 4
years and any future donations I make.
(To qualify for Gift Aid, you must pay an amount of UK Income Tax and/or Capital Gains Tax at least equal to the tax that SRH will
reclaim in your donations in the appropriate tax year. Other taxes such as Council Tax and VAT payments do not qualify).
Name …………………………..…………..……………………………………………………………………………….
Address…………………………………...…………………………………………………………………………………
……………………………………………………………………………………………………………………………….
Postcode ……………………….………
Office use: TQ Serial No’………………………………..
Signed ……………...…………………………………
Date ……………………………………..
Forget-me-not fund
If you are completing this challenge in memory of a loved one and wish all
funds to be allocated to their forget me not fund, please state the name of
the forget-me-not fund below
_______________________________________
Remember we can only allocate funds to a forget-me-not fund if we are
advised – thank you
Collection of sponsorship
Funds raised in the name of St Richard’s Hospice should be
handed over to the charity within 3 months of an event. We ask
those fundraising to endeavour to send all (or part) sponsorship
monies to St Richard’s Hospice as soon as possible and within 3
months of the event date at the latest.
Remember we need your full name and home address to be able to gift aid your sponsorship, your information will only be used for this purpose.
Let us know if you wish to receive correspondence from St. Richard’s Hospice by ticking the box below*
Title & Initial
Surname
Home Address
Post Code
Mr
A
Sample
WR5 2QT
Email address
asample@emai
l.co.uk
* would you
like to hear
from us?
(please tick)
Amount
Donated
£5.00
Are you a tax
payer?
(Please tick)
Date Money
received
01.01.15
Title & Initial
For Office Use:
Surname
GA £
Home Address
NGA £
Post Code
Email address
* would you
like to hear
from us?
(please tick)
Amount
Donated
Are you a tax
payer?
(Please tick)
Grand Total: £
Date Money
received