I am taking part in the St Helena Hospice Disco Diva Midnight Walk on Saturday 27th May 2017 and
raising money for St Helena Hospice. Your sponsorship will allow St Helena Hospice to help local
people with an incurable illness to live well and die with dignity and choice.
Participant Details:
First Name: _______________________________ Surname: __________________________________
Group name: (If applicable) _________________________________________________________________
Home Address: _______________________________________________________________________
____________________________________________________________________________________
Postcode: ___________________________ Email: _________________________________________
I am walking in memory of: (If applicable) __________________________________________________
Data Protection: We would like to stay in touch with you about our news and activities. If you do not wish to
receive this information by post or phone please tick here [ ]
If you would like to be updated by email or SMS please tick here [ ]
We will never sell or swap your details with third parties and you can opt out at any time by calling the
Fundraising Team on 01206 931468
Remember you can also create your own online sponsorship page at
uk.virginmoneygiving.com/giving/ or justgiving.com/sthelena or set up at Timeless Tribute at
timelesstributefunds.org.uk
Use Gift Aid and you can make your donation worth more.
Full name + home address + postcode +
 = Gift Aid
For every £1 you give to St Helena Hospice,
we can get an extra 25 pence from HM Revenue & Customs.
Declaration: If I have ticked the box headed ‘Gift Aid √’, I confirm that I am a UK Income or Capital Gains taxpayer. I have
read this statement and want the charity named above to reclaim tax on the donation detailed below, given on the date
shown. I understand that if I pay less Income Tax / or Capital Gains tax in the current tax year than the amount of Gift Aid
claimed on all my donations it is my responsibility to pay any difference. I understand the charity will reclaim 25p of tax on
every £1 that I have given.
For office use only
RE number: ____________________
Total received: _________________
Date Received:_________________
Gift ID no: ____________________
Gift Aid amount: ________________
PLEASE COMPLETE IN BLOCK CAPITALS
**Gift Aid - Please read the declaration on the front page of this sponsorship form**
** Please note that without your full name and address we are unable to claim for Gift Aid**

Full HOME Address
Full Name
This must be your home address so that we can
claim Gift Aid.
Postcode
Gift
Aid
TOTAL
Total
Amount
Please tick if
you do not
wish to
receive news
on St Helena
Hospice and
its events?
Date
received
£
Registered Charity Number: 280919
St Helena Hospice is a company limited by guarantee. Registered in England and Wales No 01511841 Registered office: Barncroft Close, Highwoods, Colchester, CO4 9JU
PLEASE COMPLETE IN BLOCK CAPITALS
**Gift Aid - Please read the declaration on the front page of this sponsorship form**
** Please note that without your full name and address we are unable to claim for Gift Aid**

Full HOME Address
Full Name
This must be your home address so that we can
claim Gift Aid.
Postcode
Gift
Aid
TOTAL SPONSORSHIP
Total
Amount
Please tick if
you do not
wish to
receive news
on St Helena
Hospice and
its events?
Date
received
£
Registered Charity Number: 280919
St Helena Hospice is a company limited by guarantee. Registered in England and Wales No 01511841 Registered office: Barncroft Close, Highwoods, Colchester, CO4 9JU
Pay in your sponsorship money
If you have raised money using a sponsorship form, you can return your sponsorship by:
Paying by cheque
Posting a cheque payable to “St Helena Hospice" for the amount you wish to pay, remembering to
include your sponsorship form.
Send your sponsorship to: St Helena Hospice Fundraising Office, Unit 1, The Atrium, Phoenix Square,
Colchester, Essex, CO4 9AS
Paying by credit or debit card
Just call us on 01206 931468
Our lines are open Monday – Friday, 9.00am to 5.00pm.
Paying in cash
It is not safe to send cash, particularly coins, in the post. If people give you cash, you can pay this into
your own bank account and send us a cheque for the total, or bring the cash into one of our hospice
sites or the Fundraising Office, Unit 1, The Atrium, Phoenix Square, Colchester, Essex, CO4 9AS
Send us your sponsorship forms to make your fundraising worth more
Whether you pay in by post, over the phone or in person, remember to send us your sponsorship
forms so that we can claim Gift Aid, which can turn every £1 donated by UK taxpayers into £1.25, at
no cost to them or you.
Send your forms to: St Helena Hospice Fundraising Office, Unit 1, The Atrium, Phoenix Square,
Colchester, Essex, CO4 9AS.
Online fundraising
If you have an online fundraising page, the money you raise is automatically sent to us.
Registered Charity Number: 280919
St Helena Hospice is a company limited by guarantee. Registered in England and Wales No 01511841 Registered office: Barncroft Close, Highwoods, Colchester, CO4 9JU