» In Memory Donation

Give a gift in memory

To give a gift in memory of a loved one please fill out the form below, you will have the option to light a candle in their memory.

Donation Type(Required)

In Memory

In Memory Gift(Required)

£24

£50

£70

Other

Single Gift Custom Amount(Required)

giftaid it

In order to Gift Aid your donation you must select yes to agree to the statement below:

Please treat THIS donation made to The Leprosy Mission as a Gift Aid donation. 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 charitable donations in that tax year it is my responsibility to pay any difference.

If you have already made a Gift Aid declaration and your circumstances have changed, please let us know by calling us on 01733 370505. Thank you.

Would you like to Gift Aid your donation

Yes

In Memory Gift

Name of loved one(Required)

Do you want to light a candle?(Required)

Yes

How we contact you

We really value our relationship with you but to make a real impact together, it’s important we know that you’re happy to hear from us. We promise to keep your data safe and will not share your details at any time. You can read our Privacy Policy for more information.

Your details

Title

First Name(Required)

Last Name(Required)

Street Address(Required)

Address 2

Address 3

City/Town

County

Postcode(Required)

Country(Required)

Telephone

Email(Required)

May we keep in touch by email?(Required)

Yes

Are you sure you don’t want to receive our updates? Selecting ‘No’ means you will not receive any email communication from us.

This donation is:(Required)

What prompted my donation:(Required)

Other reason(Required)

Church or Group Details

Which Church, business or group you are part of?(Required)

Not found?

I can’t find my church, business or group

Enter church, business or group name(Required)

Town or city where your church, group or business is located(Required)

Your bank account details

Payment Method

Card

Paypal

Card(Required)

Payment Method

MasterCard

Visa

Supported Credit Cards: MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name

Name on Account(Required)

Account Number(Required)

Sort Code(Required)

Total