Dedication Form - Light up a Life

Dedicate a light in memory of someone special. As a thank you, you will receive a Christmas card and two tags - to display on the Tree of Life and in your own home. Please complete your form by Friday 11th December to receive your tree tags in time for Christmas.

Dedications Form

Your dedication

Name of loved one

Their relationship to you

Your memory

Dedicated by

Select Category

Upload Dedication Image

Choose File

Are you happy for us to share your message at the Torchlight Procession or in our marketing, if appropriate?

Yes

Your donation

Our suggested pricepoints show the impact of your support, and allow us to sustain our services across Lincolnshire.

Suggested donation amount...

£34 could help keep our bereavement helpline there for families when they need it most

£83 could give nurses like Wendy time to sit with a patient, hold their hand, and reassure the family beside them

£115 could help our Inpatient Unit care for patients and families with compassion and dignity

Other amount

Custom payment amount

Don't forget to Gift Aid it

It's easy, fast and won't cost you a penny. By ticking ‘yes’ below, for every £1 you give, we will receive an extra 25p from the government at no extra cost to yourself.

Gift Aid

Add Gift Aid to my donation

I am not eligible for Gift Aid

I want to Gift Aid any donations I make in the future or have made in the past 4 years to this charity. 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.

Title

First Name

Last Name

Address

Address Line 1

Address Line 2

City

County

Post Code

Phone Number

Keep in Touch

As part of our legitimate interest we will continue to write to you unless you inform us that you want us to stop. We will not sell your data and it will only be used for Hospice purposes. A copy of our latest privacy policy is available on our website and on request. You can update your preferences at any time by contacting our Supporter Engagement Team on [email protected] or 01522 540 300.

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Would you like to hear about how to leave a gift in your Will to St Barnabas?

Yes

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