Donation formMake a donation Thank you for making a donation of £ 20.00.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 AmountReason for DonationIn memoryGeneral donationPay in money raisedCycle Challenge 2019Bedside FundOtherName of person you're giving in memory of*Relationship of person you're giving in memory of*General Donation ReasonYour DetailsHow did you raise money?Other reasoningTitle*MrDrMissMrsMsOtherOther*Forename*Surname*Company/Organisation name if applicableAddress* Address line 1 Address line 2 Town/City County / State Postcode Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSaint MartinSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Email address* Enter Email Confirm Email Telephone*MobileI would like to receive my Thank You via*EmailPostNeitherGift 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 TaxpayerPilgrims 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 hereIf you would be happy for us to contact you by email please tick hereIf 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@example.com.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.