Monthly Donation Form

If you would like to make a single donation, please see here

Memory Tree - Monthly Donation

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Name*

First Last

Address*

Street Address Address Line 2 City County / State / Region Eircode Country

Email*

Phone

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Is this leaf new or a renewal?*

New

Renewal

Is this leaf new or a renewal?*

New

Renewal

Message For Your Leaf

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Your Leaf

Bronze Leaf

Price: € 8.50

Please note this is paid monthly.

Silver Leaf

Price: € 12.50

Please note this is paid monthly.

Gold Leaf

Price: € 21.00

Please note this is paid monthly.

Total

Please note this is the total you pay monthly.

Method of Payment*

Card Details

Cardholder Name

Please check the box below to proceed.*

I confirm I wish to set up a Recurring payment

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Please note we will retain your details on the Galway Hospice Donor database. We promise to keep your details safe and never sell or swap your details with third parties. Our Privacy Notice at www.galwayhospice.ie/privacypolicy explains how we keep this promise. You can withdraw or change your consent at any time by contacting the Fundraising Department on 091 770868 or by fundraising@galwayhospice.ie or by using the opt out function available on all our communications.

Name

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Memory Tree - Monthly Donation

Your Leaf

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