Help us protect hospice care and raise £40,000 in just 24 hours so more people in Coventry and Warwickshire can access a Hospice Bed! "*" indicates required fields Step 1 of 2 - Your Donation 0% Reference Your donation... I am donating on behalf of...* Myself An organisation Please tell us the name of your company / organisation / school*You'll be able to provide your personal details later, and confirm if they match your preferred payment details.Why are you supporting Myton?Feel free to select more than one option here. In memory Thanks for care Hospice movement Local charity Other First name of your loved one*Surname of your loved one*Their relationship to you*If other please tell us why you are supporting Myton (optional)Please select your gift... £30 could fund one hour of specialist nursing care £60 could fund the cost of two hours’ specialist nursing care £90 could fund the cost of three hours’ specialist nursing care £180 could fund the cost of six hours’ specialist nursing care £360 could fund the cost of 12 hours’ specialist nursing care £720 could fund the cost of 24 hours’ specialist nursing care £1,440 could fund the cost of 48 hours' specialist nursing care A gift of my choice Please select your gift amount* Would you like a postal acknowledgement for this donation?* Yes No Would you like to add 2% as an optional donation to cover our payment processing fees? Like all charities, we incur processing fees on online donations. By adding just 2% to your gift, you can help ensure The Myton Hospices receives more of your generous support. You can remove this optional donation below. Processing Donation £ 0.00 Would you like to add 2% to help cover card processing fees?* Yes please, I wish for Myton to receive as much of my donation as possible! No thank you Your total gift Your details... Title* Mr Mrs Miss Ms Dr First name*Surname*Email* Mobile number*Your address... 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Yes No First name on Debit or Credit Card*Surname on Debit or Credit Card*Address line 1 on Debit or Credit Card*Address line 2 on Debit or Credit CardCity / Town on Debit or Credit Card*Postcode on Debit or Credit Card (Numbers and Letters Only)*Country on your Debit or Credit Card*United KingdomAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweBilling State***Please select a state**ALAKASAZARCACOCTDEDCFMFLGAGUHIIDILINIAKSKYLAMEMHMDMAMIMNMSMOMTNENVNHNJNMNYNCNDMPOHOKORPWPAPRRISCSDTNTXUTVTVIVAWAWVWIWYIs there anything you wish for us to know about your kind gift to The Myton Hospices? (optional) I wish to Gift Aid my donation and increase its worth by 25% at no cost to me... I am a UK taxpayer and would like The Myton Hospices to treat this donation, any donations I make in the future, and any I have made in the past four years, as Gift Aid donations until I notify you otherwise. I understand that if I pay less Income Tax and/or Capital Gains Tax than the amount of Gift Aid claimed on all my donations in that tax year, it is my responsibility to pay any difference.Giftaid* Yes, I want to add Gift Aid No, I am NOT a UK taxpayer or do not wish to Gift Aid my donations This field is hidden when viewing the formGA Date Four YearsThis field is hidden when viewing the formGA Date today DD slash MM slash YYYY This field is hidden when viewing the formGA No Date DD slash MM slash YYYY Find out the difference your support makes... Thank you for supporting The Myton Hospices so we can continue to provide our services free of charge to people, and their families, living with terminal illnesses. We may keep in touch with you by post and phone to tell you more about our vital work and other ways you can help, including opportunities to donate, fundraise or volunteer and how your support has made a difference. Please let us know if you’re also happy to hear from us by email and text: By email* Yes No By text* Yes No Leave a Lasting Legacy... Did you know that 1 in 4 of our patients are cared for by Gifts in Wills? You don’t have to be wealthy to make a difference to people’s lives; large or small, a gift from you can help our patients and their families at a time when they need us the most. By including a gift in your Will for Myton you will be supporting your local charity, making a positive difference for your community and leaving a lasting legacy.Gift in Wills Post me a free Gifts in Wills pack Your privacy... We promise to do our best to keep your details safe and secure and will only process your data in accordance with the current Data Protection legislation. Our Privacy Policy explains how we keep this promise and you can read more online at www.mytonhospice.org/privacy-policy If you change your mind about hearing from us please email DSCT@mytonhospice.org or call us on 01926 358383. I have read and accept The Myton Hospices Privacy Policy* I accept Total This field is hidden when viewing the formDONATEThis field is hidden when viewing the formEXTRAThis field is hidden when viewing the formTOTAL DONATION To speak to a member of the team please call 01926 358 383 or email Enquiries@mytonhospice.org
