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 ReasonHow did you raise money?*Other reasoningIf 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 NameAddress* Address line 1 Address line 2 Town/City County / State Postcode Country AfghánistánAlbánieAlžírskoAmerická SamoaAndorraAngolaAnguillaAntarktidaAntigua a BarbudaArgentinaArménieArubaAustrálieBahamyBahrainBangladéšBarbadosBelgieBelizeBeninBermudyBhútánBolívieBonaire, Sint Eustatius a SabaBosna a HercegovinaBotswanaBouvetův ostrovBrazílieBritské indickooceánské územíBrunei DarussalamBulharskoBurkina FasoBurundiBěloruskoCape VerdeChileChorvatskoCocos IslandsCongo, Democratic Republic of theCookovy ostrovyCosta RicaCuraçaoCzechiaCôte d'IvoireDominicaDominikánská RepublikaDánskoDžibutiEgyptEkvádorEritreaEstonskoEswatiniEtiopieFaerské ostrovyFalklandské ostrovyFederativní státy MikronésieFijiFilipínyFinskoFrancieFrancouzská GuyanaFrancouzská PolynesieFrancouzská jižní územíGabonGambieGhanaGibraltarGrenadaGruzieGrónskoGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeardův ostrov a McDonaldovy ostrovyHoly SeeHondurasHongkongIndieIndonésieIrskoIrákIslandItálieIzraelJamajkaJaponskoJemenJerseyJižní AfrikaJižní Georgie a Jižní Sandwichovy ostrovyJižní SúdánJordánKajmanské ostrovyKambodžaKamerunKanadaKatarKazachstánKeňaKiribatiKolumbieKomoryKorea, Democratic People's Republic ofKorea, Republic ofKubaKuwaitKyprKyrgyzstánLao People's Democratic RepublicLesothoLibanonLiberieLibyeLichtenštejnskoLitvaLotyšskoLucemburskoMacaoMadagaskarMalajsieMalawiMaledivyMaliMaltaMarokoMarshallovy ostrovyMartinikMauritiusMauritánieMayotteMaďarskoMexikoMoldavskoMonakoMongolskoMontserratMosambikMyanmarNamibieNauruNepálNigerNigérieNikaraguaNiueNizozemskoNorskoNorth MacedoniaNorthern Mariana IslandsNová KaledonieNový ZélandNěmeckoOmánOstrov ManOstrov NorfolkOstrovy Turks a CacoisPalauPalestine, State ofPanamaPapua-Nová GuineaParaguayPeruPitcairnPolskoPorto RicoPortugalskoPákistánRakouskoRepublika KongoRovníková GuineaRumunskoRussian FederationRwandaRéunionSaint Helena, Ascension and Tristan da CunhaSaint MartinSaint Pierre a MiquelonSalvadorSamoaSan MarinoSao Tome and PrincipeSaudská ArábieSenegalSeychelySierra LeoneSingapurSint MaartenSlovenskoSlovinskoSolomonovy ostrovySomálskoSpojené Arabské EmirátySrbskoSrí LankaStředoafrická republikaSurinamSvalbard a Jan MayenSvatá LucieSvatý BartolomějSvatý Kryštof a NevisSvatý Vincent a GrenadinySyria Arab RepublicSúdánTanzania, the United Republic ofTchaj-wanThajskoTimor-LesteTogoTokelauTongaTrinidad a TobagoTuniskoTurkmenistánTuvaluTádžikistánTürkiyeUS Minor Outlying IslandsUSAUgandaUkrajinaUruguayUzbekistánVanuatuVelká BritánieVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Vánoční ostrovWallis a FutunaZambieZimbabweZápadní SaharaÁzerbajdžánÅlandské ostrovyÍránČadČerná HoraČínaŘeckoŠpanělskoŠvédskoŠvýcarsko 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 [email protected]. 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.