Leave a gift in your will pack form

First Name*

Last Name*

Email*

Home Address*

Postcode*

Phone number*

Date of birth*

Would you also like to receive a copy of the pack in the post?

Once you click submit you will be provided with your free online pack. Would you also like to receive a free pack in the post?

Yes, I'd like to receive a pack in the post

Marketing permissions

We would like to contact you in the future about the impact of your generous support. If you would prefer not to hear from us in the future, you can opt-out using the checkboxes below.

No, I don't want to be contacted by post
No, I don't want to be contacted over the phone

Email preferences

We would like to email you about other ways you can help support the staff and patients at your local hospitals. Please tick the below box to hear from us via email.

Yes, I’d like to hear from you via email

The Charity is committed to protecting your privacy, personal information and confidentiality and we take our data protection responsibilities very seriously. For more information, please read our privacy policy.

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Thank you for your support – it makes a huge difference to our patients, their families and our staff.