Donation form Make a donation Pilgrims helps thousands of people in east Kent each year who are facing incurable illness to live well in every moment. We do this by offering a range of support them, their carers and family at this difficult time in their life. Your donation will help us continue to provide this care for the next person that needs us. Thank you! Donation Amount* Donation Amount (LEGACY OPTION)Reason for Donation*Please select a reasonGeneral donationIn memoryPay in money raisedQR codeIn LieuOther What celebration are you donating in lieu of?* Name of person whose celebration it is* Please provide any additional details about this donation (Optional)Name of person you're giving in memory of* Relationship of person you're giving in memory of* Is this donation part of a funeral collection? Yes General Donation Reason How did you raise money?* Other reasoning If you would like to leave us a message, please do so below:Promotion Consent* I am happy for this message to be used in promotion I would not like this message to be used in promotion Your DetailsTitle*MrDrMissMrsMsOtherOther* Forename* Surname* Are you making this donation on behalf of a company or organisation?* Yes No Company/Organisation Name Address* Address line 1 Address line 2 Town/City County / State Postcode Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Email address* Enter Email Confirm Email Telephone*MobileI would like to receive my Thank You via* Email Post Neither Gift Aid - Increase the value of your gift by 25% Yes. Please treat all donations I make now, in the future, or have made to Pilgrims Hospices for the past 4 years as Gift Aid donations until further notice. I am a UK taxpayer and 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 my donations it is my responsibility to pay any difference. I understand that Pilgrims Hospices will reclaim 25p of tax on every £1 that I have given. I am not a UK Taxpayer Pilgrims Hospices will keep you up to date with exciting news, information and ways you can support us by post. If you would prefer not to receive information by post please tick here If you would be happy for us to contact you by email please tick here If you wish to adjust the frequency or type of communications you receive from Pilgrims, please call Supporter Relations on 01227 782062 or email us at supporter.relations@pilgrimshospices.org. Funds received will be used in accordance with Pilgrims Hospices vision to ensure that people with a terminal illness and their family and friends are supported and empowered to live well in mind and body until the very last moment of their life.