Coinote Services, supporting the Teesside Hospice, donation form

	Coinote supporting the
	Registered Charity No. 512875

The Teesside Hospice Donation Form

Please print this form and mail it direct to Teesside Hospice

I would like to support the work of the Teesside Hospice by making a donation of;

£_______________________

Cheques should be made payable to "Teesside Hospice"

Title______ Initial______ Surname________________________

Address_____________________________________________

Town__________________________ Postcode______________

Please tick the box if you;

Wish to be a friend of the Hospice

Would like to sign a covenant

Wish to join our lottery

Would like to become a volunteer

Have goods to donate for our charity shops

Would take a collecting box

Would like to sell Hospice merchandise

Would like to receive a newsletter

Wish to discuss a possible fundraising event

Please print this form and mail it direct to

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