Virtual Reality Appeal form Virtual Reality Appeal form Immerse Your Senses Appeal 2019 Your detailsTitle*MrMissMrsMsDrOtherOther First Name* Surname* Your Gender*MaleFemaleAddress* Street Address Address Line 2 City County / State / Region ZIP / Postal Code Telephone*Email* Enter Email Confirm Email If you'd like to receive emails about other ways to support Pilgrims Hospices or with news about our work, please tick the box below. I'm happy to receive emails where possible Please accept my gift to Pilgrims Hospices of:*£100£50£35£20OtherDonation amount (other)* Total £ 0.00 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 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. 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