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      • (Please note that dedications must be no more than 26 characters, including spaces)

    • Please select which dedication you would like to make to your loved one

        • Bronze Leaf

          £100 a year / £9 a month (Minimum suggested donation)

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        • Silver Leaf

          £200 a year / £17.50 a month (Minimum suggested donation)

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        • Gold Leaf

          £300 a year / £26 a month (Minimum suggested donation)

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        • Sunflower

          £500 a year / £43 a month (Minimum suggested donation)

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    • Your payments

      Your regular donation will be administered by GoCardless. They will take your first payment in the next 7 to 10 days and your second payment will come out on or near your preferred date.

      • Please specify your preferred collection date. If the collection date selected falls within the next 6 days, the first payment may be collected the following month.

        • I want to Gift Aid my donation and any donations I make in the future or have made in the past 4 years to St. Michael’s Hospice (North Hampshire). I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year it is my responsibility to pay any difference. Please notify us if you wish to cancel this declaration, change your name or home address or no longer pay sufficient tax on your Income and/or Capital Gains. If you pay Income Tax at a higher or additional rate and want to receive additional tax relief due to you, you must include all your Gift Aid donations on your Self-Assessment tax return or ask HM Revenue and Customs to adjust your tax code.