Printable on line Donation Form
Please fill in the form on line, and use your browser print function to print it out. Post it to us using ether of the addresses below depending whether or not you wish to use the freepost service	Note: you may freely use our FREEPOST address, however using the other address and affixing a stamp will save the Hospice administration charges
Harlington Hospice Association Lansdowne House St Peters Way Harlington Middlesex UB3 5AB	Harlington Hospice Association FREEPOST (SCE14380) HAYES UB3 5BR

From: -

Name

Address

Please

Include your

Postcode

Phone no

Email

I enclose monies to the sum of:

(Please make cheques payable to the “HARLINGTON HOSPICE ASSOCIATION”)

Gift Aid increases the value of your donation by 28% without affecting your tax position.

If you are not a UK tax payer or do not wish for your donation to be included in the scheme

please write no here