Coinote Services supporting the Hartlepool & District Hospice, donation form

	Coinote supporting the Hartlepool & District Hospice
	Registered Charity No. 510824

The Hartlepool & District Hospice Donation Form

Please print this form and mail it direct to The Hartlepool & District Hospice

I would like to support the work of the Hartlepool & District Hospice by making a donation of;

£_______________________

Cheques should be made payable to "Hartlepool & District 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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